A TREATISE 



EPIDEMIC CHOLERA. 



HORATIO GATES JAMESON, Senr., M.D., 

MEMBER OF THE MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND; PROFESSOR OF SURGERY; 
MEMBER OF PHILOSOPHICAL SOCIETIES OF BERLIN AND MOSCOW, ETC. 




PHILADELPHIA: 
LINDSAY & BLAKISTON. 

1855. 



Entered, according to Act of Congress, in the year 1855, by 
LINDSAY & BLAKISTOX, 

Iii the Clerk's Office of the District Court of the United States, for the Eastern 
District of Pennsylvania. 



C. S n E R M A N & SON, PRINTERS, 

19 St. James Street. 



Custom seems to require that I dedicate this treatise to some illustrious 
patron; but in the present case this could only be done invidiously, since it. 
comes before the public under the auspices of several hundred subscribers, 
I delight to recall the many flattering receptions, and warmly expressed 
good wishes of prominent members of our noble profession. The fraternal 
impulses, which adorn the members of the medical faculty, have more than 
lightened my labors; — while they have stimulated me onwards they have 
heightened my esteem for our noble calling. 



ERRATA. 

Page 37. 2d line from top, for §ij. read 3ij. 

" 51,3d " '• li for half pound read half an ounce. 
; ' 78. 3d ' : " botlom. for of read to. 



INTRODUCTION. 



It has been our design to make the present work eminently 
practical, while we at the same time impress upon it the cha- 
racter of an American work. It is the clinical department 
we would endeavor to improve. The minutiae of the closet, 
whether appertaining to animal chemistry, or pathology, though 
highly ornamental in our profession, can only be located among 
things that are dead. Careful observation upon bodies that 
are alive, must ever be the guide to him who would scan the 
phenomena which prevail in the morbific actions of the animal 
body. 

In strict language, things are not forces, neither are forces 
things. The marks of loedentia are seen upon the dead, but 
the keeping power is gone ; we may analyze all that remains, 
but there is too often no key to unlock the mysteries of un- 
sound life. . Life consists of things and forces ; in the dead the 
forces are extinct. Hence it is that we must get the living 
signs of disease, not the dead. 

Analytically, much has been done, but synthetically, our 
powers are poor indeed. Much may be done to adorn the 
science of medicine, and much light has been thrown upon the 
nature of many diseases by the study of pathology ; but unfortu- 
nately, what we desire to control is not to be got at, and it 
turns out, too often, that things visible after death, do not pre- 
sent the disease, but the result of the morbid actions ; and as 
there is no resuscitation of the whole dead body, so neither is 
there any power of replacement of vital parts, that have lost 
their vital influence. 

We claim to be practical, we therefore proceed to announce 
that, we have aimed to established the non-contagiousness of 



XIV INTRODUCTION. 

cholera, believing the opposite opinion both erroneous and re- 
plete with evil to society. In doing this, we have endeavored 
to explain the nature of the cause of epidemic cholera. 

Our therapia will be found differing in some measure from 
that that has been generally recommended, and, we think, 
sufficiently tested to be relied on, wherever it can be applied 
under like circumstances. We also consider our specialities of 
much importance, as the treatment was mostly successful, and 
the reader can rely upon our strict adherence to the truth, nor 
have we reserved unfortunate cases that were under strong 
and special treatment. The minor defects, we indulge the 
hope will be overlooked. 



CONTENTS. 



Morbific Constitutions, 
Epidemics, 
Typhus Fever, 
Bilious Epidemic of 1804, 
Antecedent Cause of Cholera, 
Cholera at Hamburg, 
Population of Hamburg, 
Announcement of Cholera, 
Dissections at Hamburg, 
Health Commission at Hamburg, 
Dissections at Moscow, 
Special Remarks at Hamburg, 
Vivisections at Berlin, 
Transfusion in Cholera, 
Presence of Air in the Heart, . 
Diffenbauch's Experiments, 
u on Transfusion, 
Cholera and Cholera Morbus, 
Madras Medical Board (History), 
Remarks on Madras Board, 
Philadelphia Commission (Cholera) 
Character of Cholera, 
Cholera Non-Migratory, 
Nature of Cholera, 
Public Means for Prevention, 
Personal Means of Prevention, 
Symptoms of Cholera, 
Cholerine, . 
Cholero-dysentery, 
Cholera Lethalis, . 
Cholera in Baltimore, . 
Board of Health, Savannah, 
Hospital Practice 1832 (Baltimore), 
Anomalies in Cholera, 
Hospital No. 3, Baltimore, 



17 
22 
25 
26 
29 
30 
33 
34 
38 
40 
51 
51 
54 
61 
62 
65 
67 
69 
71 
74 
76 
79 
80 
82 
91 
93 
95 
96 
97 
97 
102 
111 
114 
117 
119 



Antiphlogistic Treatment, . 

Cholera Specialities in 1832, . 

Transfusion by Dr. Rees, . 

Abatement of Cholera, 

Antiphlogistic Treatment (Special), 

Specialities in 1832 (cholera), 

Bloodletting in Spasmodic Cholera, 

Local Bleeding, 

External Heat in Cholera, 

External use of Lard, 

Prevention, Measures for, 

Cholera, Product of the Atmosphere. 

Electricity Related to Cholera, 

Diseases of Summer and Autumn, 

Prevention of Summer Diseases, . 

Dissections at Baltimore, 

Dissections at Hospital No. 3, 

Dr. Berg's Report on Contagion, 

Epidemic of 1804 extended, 

Epidemic Cholera, Columbia, . 

Influence of Altitude, 

Cholera in Paris, 

Use of Copper in Cholera, . 

Use of Sulphuric Acid, 

Cholera at York, . 

Exemption from Fever at Somerset, . 

Ozone as Related to Cholera, 

Schonbein's Views of Ozone, . 

Application of Dr. Schonbein's Views, 

Preservative power of Copper, 

Summary Views of Primary Cause, 

English Board of Health, Notification of, 

Influence of Copper "Works at Baltimore, . 

Special Observations on Columbia, 

Concentrated View of Cholera, 



PAGE 

124 
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182 
222 
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238 
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240 
246 
249 
251 
255 
257 
259 
262 
267 
275 
278 
280 



TREATISE ON EPIDEMIC CHOLERA. 



OBSERVATIONS ON MORBIFIC CONSTITUTIONS. 

Since the day of Dr. Sydenham it has been known that 
epidemic diseases are under certain laws, though to our limited 
apprehensions they have not been sufficiently manifested to 
enable observers, the most astute, to reduce our knowledge to 
systematic arrangements; nevertheless, what we do know is 
highly important. It is one of those things which is recog- 
nized by its visible operations or effects, while its tangibility 
eludes our visual powers, except, as through a glass, darkly. 

We may look to Sydenham for the first clear exposition of 
the laws governing epidemic diseases, and we now turn to his 
observations on epidemics, with especial reference to epidemic 
constitutions. This author tells us, " that the seasons of the 
year which chiefly favor any kind of diseases are necessary to 
be observed." "I have, indeed, wondered that this disposi- 
tion of some diseases, which is so obvious, has as yet been 
observed by few." This important observation of Dr. Syden- 
ham which, it appears, was but little attended to by his prede- 
cessors or cotemporaries, has been duly appreciated by a large 
proportion of the profession of the present century, and for 
this we are principally indebted to Dr. Rush. The term con- 
stitution, as referable to diseases, has been modernized into 
cycle. 

We would here pay a merited tribute of respect to the 
memory of the father of the present writer, who (the father) 
graduated at the University of Edinburgh in the day of the 
2 



18 EPIDEMIC CHOLERA. 

elder Monro, was fellow-student of the lamented General Mer- 
cer, who fell at Princeton, and they were fellow-emigrants to 
this country. Dr. Jameson practised physic at York, Pa., 
nearly forty years, and acquired pre-eminence in his profession. 
He was a strict proselyte and follower of Sydenham, as re- 
lates to fevers of the several seasons, which, indeed, constitutes 
nearly the whole professional business of country physicians. 
Like his prototype, he studied the character of fevers, &c, as 
he proceeded from year to year, and from season to season ; 
and when, by the observance of a few cases, he saw the pecu- 
liar cast of cases present, he, from day to day, put into his day- 
book, " fever of the season." And we have had reason to feel 
truly thankful for early lessons, which have served as a beacon 
by which we have been guided, and, as it has become more 
familiar, has become more precious in our sight. This guide 
and instructor enabled us early to discard or mistrust nosology, 
and to be wary in paying too much devotion to pathological 
theories. 

Speaking of certain epidemics, Sydenham says, "This I am 
sure of by many observations, that the above-mentioned dis- 
eases, especially fevers, do very much differ ; for that method 
which is successful one year may, perhaps, be destructive 
another." The neglect of this admonition has involved doc- 
trines respecting epidemics in much obscurity. Our author, 
speaking of his pains to observe the particular changes of the 
weather upon epidemics, says, "I perceive that years that 
agree as to the manifest temperature of the air are infested 
with various diseases;" "and thus it happens that there are 
many constitutions of years, that arise neither from heat, nor 
cold, nor moisture, nor drought, but proceed from a secret and 
inexplicable alteration in the bowels of the earth, whereby the 
air is contaminated with effluvia, as dispose to this or that dis- 
ease, as long as the same constitution prevails." "Every one 
of these constitutions is accompanied with a fever proper and 
peculiar to itself." We need scarcely stop here to tell the 
reader that these supposed effluvia from the bowels of the 
earth, which are the cause of many of our fevers, are now 
almost universally recognized under the names of miasm, or 



MORBIFIC CONSTITUTIONS. 19 

malaria; but atmospherical constitutions are comparatively 
secret and inexplicable. 

In support of the method of Sydenham, as relates to epi- 
demical constitutions of the atmosphere, and in opposition to 
nosology, or a too exclusive employment of pathological 
theories, he says, " There are other years which, though they 
be epidemical, yet are they so irregular that they cannot be 
comprehended under any one form, and are indeed ill-condi- 
tioned." Ample experience confirms these views of our author; 
and we shall see, as we proceed in our observations upon epi- 
demic cholera, that it has presented strong features of this 
trait. Sydenham says again: "Diseases may vary often in 
one and the same constitution, which is of so great consequence, 
that the curative indications are to be omitted, or used accord- 
ing as the disease is disposed." The writings of Dr. Syden- 
ham fully establish this important truth ; and we have a strong 
illustration of it in Dr. Rush's account of the yellow fever of 
1793 in Philadelphia ; and it is quite in accordance with our 
own experience. 

Sydenham has remarked, that "when autumnal intermittents 
appear in July, they do not always put on their own peculiar 
symptoms ; and tha,t we must carefully distinguish intermittent 
fevers from continual fevers, which they resemble." Again, it is 
said: "When many diseases infest the same year, one is more 
predominant, and all the rest are, as it were, under it, and don't 
rage so much at that time." Subsequent observation has con- 
firmed this opinion. This must have a strong bearing on our 
practice, since all the diseases cotemporaneous with the main 
disease, but of inferior force, will principally partake of the 
character of the predominant disease. Sydenham has there- 
fore correctly said, "Diseases which have been called putrid, 
malignant, spotted, and the like, ought rather to be named 
after the constitution." The peculiar constitution will give 
rise to specific antecedent causes, that will more or less govern 
all diseases of the epidemic kind. 

" Seeing that the specifical differences of popular diseases, 
viz., fevers from secret constitutions of years, those labor in 
vain who deduce the reasons of divers fevers from a morbific 



20 EPIDEMIC CHOLERA. 

cause reserved within the body." These remarks are no less 
true now than they were in the time of Sydenham. They 
apply equally well to the cerebral theory of Clutterbuck, and 
that of the tubular viscera of Broussais. The author before us 
continues: "But, how shall we give an account of the distinct 
species of epidemics that do not only (at least so it appears 
to us) invade by chance, but for one year, or one certain 
series of years, are of one genus, and in another year are dis- 
tinguished in species one from another ? Why, in this case, 
no method seemed more fit to me than that which describes 
them, in the order they may succeed one another, for a suffi- 
cient number of years, which, that I may do according to my 
own method, I will first fully deliver to the learned world the 
histories and cures of these epidemics (as well as I could pos- 
sibly collect from the most accurate observations) that did rage 
from the year 1661 to 1684." 

Does not the fact that system after system of nosology has 
fallen into ruin, since the time of Sydenham, add support to 
the accuracy of his views generally, as relates to epidemic dis- 
eases? We think the latest observations and experience sustain 
his views ; and it is by the atmospherical constitutional plan, 
as relates both to theory and practice, that we can safely 
engraft pathological views, and pursue successful modes of 
treatment. 

Dr. Sydenham describes six different constitutions, which 
embrace the epidemic and febrile diseases, of which he treats. 
The first constitution began with 1661, and ended in 1665. 
The second embraced one year, from 1665 to 1666 ; during 
this period the principal disease was of a typhoid character; 
but more inflammatory than that of the preceding constitution : 
in this constitution, it will be recollected, raged the great 
plague of London. A third constitution existed from the ter- 
mination of 1666 to 1669. The epidemics of this period were 
distinguishable, in part, by the unusual pernicious effects at- 
tending the use of stimulants. The fourth constitution in- 
cluded a part of the year 1669, and extended to the year 1672. 
During this term, dysentery was the most prevalent form of 
disease ; but it is evident that diseases of this constitution were 



MORBIFIC CONSTITUTIONS. 21 

of a low grade, since opium was found of such high importance 
as to draw from our author the strongest possible praise. The 
sixth constitution extended through the years 1673, '4 and '5. 
In this constitution diseases were now again of a decidedly 
inflammatory character, yet they yielded readily to the bark, 
after moderate evacuations. This epidemic seems to have been 
of milder grade than those of preceding constitutions, — de- 
pending, no doubt, on common miasm, of like nature with that 
which has, in former years, operated as the remote cause of 
our intermittent and remittent autumnal fevers, through our 
Middle and Southern States. 

We think the foregoing observations and views (first clearly) 
promulgated by Sydenham, and cherished and amplified by 
Rush, afford a platform on which to rest whatever knowledge 
we have acquired respecting epidemics, and, in an especial 
manner, applies to cholera ; and, equally so, in its sporadic, 
endemic, or epidemic aspects. And it is our decided opinion, 
that the atmospherical constitution, which begets cholera, 
throughout this and European countries, has existed ever since 
the year 1882 : in some parts of Europe longer. 

We do not mean to say that cholera is more under the in- 
fluence of a reigning constitution than other diseases, such as 
have prevailed in this country since its settlement; but it 
seems proper to say, that the cholera constitution has, in some 
degree, usurped that of our miasmatic fevers. In both consti- 
tutions there are changes and modifications ; and hence the 
truth of Sydenham's observation, u there are other years which, 
though they be epidemic, yet are they so irregular that they 
cannot be comprehended under any one form, and are indeed 
ill-conditioned." This accounts for the irregular blending of 
ordinary bilious fevers and cholera, prevailing in different parts 
of our country at one and the same time. All this, however, 
does not invalidate what we have offered in support of atmo- 
spherical constitutions, which rise up, and have their periods of 
advance, duration, and declination. 

And it is for want of attention to this view of epidemic 
diseases, and particularly cholera, that some of our profession 
are in doubt ; and some others, with a large portion of the 



2Z EPIDEMIC CHOLERA. 

populace, believe cholera to be contagious, — an error of opinion 
this, that, it seems to us, to be almost a waste of words to at- 
tempt to disprove. As we proceed, we shall, however, offer 
observations on this point, — a point which we deem a matter of 
momentous importance, since much mischief is continually 
growing out of this error. Cholera, not being long stationary, 
but showing itself now here, now there, is thus, to each neigh- 
borhood, kept in good degree a stranger; and coming with 
destructive force, place after place is panic-struck for a period 
of more or less time, and many things thus arise to increase 
the mortality, and frighten the people, as well as some phy- 
sicians, from their propriety, in whatever relates to the disease. 
With a view of placing this part of our subject before the 
profession of medicine, we shall endeavor to unfold such obser- 
vations and views, concerning epidemic cholera, as we believe 
are tangible and true ; and if so, may serve to elucidate a sub- 
ject which has perplexed many observers; and if it should, 
after all, turn out that this disease will have its victims, when 
seized on, we shall know better how to ward it off; and, to see 
things in their true character, is at least the beginning of 
knowledge ; then let us here, as in other departments of know- 
ledge, endeavor to gain power by inquiry into whatever apper- 
tains to the cause and nature of epidemic cholera, and we hope 
thence to derive such views as will lessen the destruction to 
human life ; in doing which, it will appear that if many die of 
cholera, fewer now die of other diseases during a cholera con- 
stitution of the atmosphere. 



OBSERVATIONS ON EPIDEMICS. 

There is nothing related to cholera of so much importance as 
to point out and establish its antecedent cause ; but we must 
have its whole character ; for, by a right understanding of its 
protean character, we may, in good degree, keep it in obeisance. 
We, therefore, deem it proper to .notice some of the epidemic 
constitutions which we have seen in the course of our practice, 
in different parts of this country. 



OBSERVATIONS ON EPIDEMICS. 23 

We shall first notice an epidemic which prevailed at Wheeling, 
on the Ohio, in 1799 and 1800. From our records of this 
disease, we present the following remarks: "The season, the 
location, and the like circumstances, will enable us to antici- 
pate, with tolerable certainty, at the beginning of an epidemic, 
whether we shall have a bilious cast of the disease, or whether 
there will be a predisposition to inflammation or congestion of 
this or that viscus ; as the lungs, intestines, &c. To these cir- 
cumstances we must always look in laying down our indications. 
We have seen several summer typhus epidemics, in all of which 
intermittents had preceded, or prevailed more or less cotempo- 
raneously, and mostly some remittents also. Where the pros- 
tration was not remarkable, and some tolerable degree of 
excitement existed, bloodletting, to moderate extent, was use- 
ful, and in a very few cases one or two repetitions were 
practised to advantage. When the fever seemed to yield, and 
much prostration began to succeed, the respiration became 
more disturbed, and there was greater evidence of sensorial 
disturbance, it became necessary to exhibit preparations of 
ammonia, sp. nitre, sulph. ether, opium, serpentaria, &c. In 
some protracted cases, where there was a gradual sinking of 
the vital powers, at the end of the second or third week, a 
little sooner or later, life seemed to depend on the use of 
stimuli; almost incredible quantities of wine and brandy were 
necessary. In some cases a pint of each was given every 
twenty-four hours, for many days, with the happiest effects, 
and sometimes carried patients through many days of almost 
total insensibility, and a total want of consciousness, though of 
temperate habits. In these protracted cases, durable stimu- 
lants or tonics were found useful. The bark, in decoction (no 
quinia then) was especially beneficial. 

Where there was evidence of unequal excitement, blis- 
ters were decidedly useful. But their effects being transient, 
and the disease one of considerable duration, it was necessary 
to re-apply them frequently ; this was done as soon as they 
dried up pretty well : two or three were applied at a time, to 
the amount sometimes of ten, twelve, and even twenty. 

It was a remarkable feature in this epidemic, that, in its 



24 EPIDEMIC CHOLERA. 

early stage, the stomach was very irritable, and a source of 
great suffering. This symptom was most readily relieved by 
small doses of calomel, and the application of mustard to the 
epigastrium and the ankles ; and yet when the disease became 
protracted, this symptom disappeared, and medicines and 
drinks were received kindly. The sensorium was so much af- 
fected as to preclude the use of food, and patients were thus 
safe from officious friends, who too often interfere with our 
patients. In a few cases it required an extraordinary degree 
of determination of purpose, and a good share of management, 
to get down such medicines and drinks as the patients required. 
We saw a few patients who lay several days entirely uncon- 
scious of everything around them, not even recognizing the 
hand that administered to their wants, who nevertheless re- 
covered. We aver truly, with high satisfaction, that, notwith- 
standing we treated many cases, none died in our hands. 

The phenomena attendant on this disease, shows it to have 
been a typhus of simple grade as its prevailing cast ; it had 
been preceded the year before by a fatal typhus, and the fever 
under notice was succeeded by remittent and intermittent fevers 
for several years, which were the product of miasm, arising 
from marshy exhalation. During the constitution under no- 
tice, say of 1799 and 1800, there was a few cases of the usual 
remitting and intermittent fevers. 

We close our observations on this epidemic by noticing an 
occurrence which we deem important : there was a competitor 
in practice in Wheeling, in our time there, who was a good deal 
older, and who had much more experience, and from him we 
received our principal views of the disease, and of its treat- 
ment, and yet our practice was far more successful than his, 
for he lost several patients. Our practice differed in nothing 
but this: we used our remedies to much greater extent than he 
did, carefully adapting them to the stage and force of the dis- 
ease, by a faithful investigation, morning, noon, and evening, 
where the location of the patient admitted of it, and they were 
nearly all in town. It seems proper that we should mention 
here, that with some of our patients wine could not be pro- 
cured. In such cases, we used whiskey with equal success. 



EPIDEMIC TYPHUS FEVER IN BALTIMORE. 25 



EPIDEMIC TYPHUS FEVER IN BALTIMORE. 

We attended many cases of typhus fever in the year 1819, 
which presented the simple form as its prevailing character. 
In this epidemic there was not, generally, any considerable ex- 
citement ; and, in some cases, there was not any observable, 
excepting increased heat of the skin. The stomach was often 
very irritable; indeed, this was one of the most uniform and 
distressing symptoms. Pretty nearly the same treatment was 
employed here as in the epidemic we have noticed as prevailing 
in 1799 and 1800 ; but it was not found proper or safe to carry 
remedies to the same extent, and especially we found a de- 
cided difference as regarded the use of blisters ; they did not 
seem to be so useful as they were in the fever of 1799. Al- 
though it was, in the main, simple typhus, it was more fatal 
than the fever of the constitution of 1799. 

The typhus and typhoid grades of fever were prevalent in 
Baltimore about the year 1819, and for some years previous ; 
but the stomach being much concerned, and the views of 
Broussais being then in vogue, it went, perhaps, generally by 
the name of gastric fever. The cases, now under especial no- 
tice, existed at the Baltimore Jail, while we held the appoint- 
ment of physician to that institution, and it had a duration of 
about eighteen months. At a time that there was nothing new 
or remarkable in the building, food, or anything else, this fever 
broke out, and was continued all its term in one wing of the 
premises only. It existed in all the seasons nearly the same, 
being a little more common in the winter season. It suddenly 
disappeared in the month of March, without any known cause, 
after having afflicted about forty persons during the preceding 
winter. After this our diseases became more openly bilious, 
and a constitution set in for about three years, in which yellow 
fever prevailed, in districts of alluvial soil in Baltimore, twice 
as an epidemic. 



26 EPIDEMIC CHOLERA. 



BILIOUS EPIDEMIC OF 1804. 

All who are old enough will recollect that a bilious epidemic 
prevailed, to a most extraordinary extent, throughout the 
Middle States, in the year 1804. In that year, along every 
stream of water, and in low places, there was to be seen whole 
families of ten or twelve persons, in some instances, ill of 
this fever. The mortality was moderate, although bilious remit- 
ting fever was more common than the intermittent. The disease 
was what we would term, simple bilious fever, or disease, the 
result of the common miasm or marsh effluvia. And in this, 
as in all other epidemics, the character was best known by 
the treatment to which it yielded. We saw much of the dis- 
ease, and found our practice alike simple and successful. The 
bark could be used efficiently in remittents, without much 
regard to remissions of the fever, after evacuating the first 
passages by the use of calomel and jalap, followed, in some 
cases, with an emetic of tart. pot. et ant. or ipecacuanha. The 
disease existed several weeks ; and such was the general use of 
the cinchona, that it rose in Baltimore to four dollars a pound 
for the pale and yellow, and six for the red sort. It seems 
proper to remark here, that the bark, as it was then called, 
had not been analyzed, and the profession were, in error as to 
the superiority of the red bark, owing, perhaps, to its greater 
astringency; this, and perhaps its comparative scarcity, led, 
we suppose, to the high price. But we were assured by a re- 
spectable apothecary that druggists were in the habit of coun- 
terfeiting the red cinchona by means of tincture of red saunders. 
Later experience shows the fraud only applied to the price, 
since the other varieties of bark contain more quinine than the 
cinchona rubra. Would that all adulteration were as innocent. 

Let us here ask the broad question, can there be any diffi- 
culty in comprehending what is meant by an atmospherical 
constitution or cycle ? Here is not only presented an extra- 
ordinary amount of disease, but there is a sameness of charac- 
ter which could not be explained on any ground except that of 
atmospherical contamination. This, though widely diffused, 



BILIOUS EPIDEMIC OF 1804. 27 

was manifestly more concentrated and active along water- 
courses, where it is more or less evident by its effects every 
summer and autumn. 

If we admit the position which we have taken to be true, and 
if, in the course of years of observation, we find diseases pre- 
senting different characteristics in the seasons when and where 
miasmatic diseases have heretofore prevailed, there can, we 
think, be no doubt but the new disease is occasioned by some 
contamination of the air somehow modified. Since the time of 
Lavoisier and Fourcroy, it has been known that chemical 
agents, in most instances, in entering into new combinations, 
unite only in definite proportions. And it follows, that the 
same elementary particles, uniting in different proportions, 
form different compounds — primary and secondary, &c, and 
these compounds will be quite different in their nature. Sup- 
pose we have ascertained that the effluvia of marshes can be 
shown to consist principally of ozone; this will show that 
miasm from vegetable putrefaction has heretofore given rise to 
our ordinary fevers in the fall season. We have here a cause, 
and the result of that cause is bilious disease of different 
grades; but, while the same materials, which produce the 
ozone, remain, and without any visible cause, the place of 
bilious fever is usurped by a new disease, are we not warranted 
in drawing the conclusion that the poison in the air has 
changed ? And if so, are we not also warranted in believing that 
the change is owing to a new combination. We see that the 
same elements may, and do, as a regular law, produce dif- 
ferent compounds, &c, &c, and nothing is better known 
than that these compounds may be most decidedly different 
We shall endeavor hereafter to show a new principle extant in 
the air. 

It seems to follow, that however exalted the achievement of 
the chemist, in bringing to our cognizance the product ob- 
tained from malaria in the form of ozone, still little is achieved 
as regards our therapia. Here we may see that ozone pro- 
duces ordinary fevers ; but we cannot admit that exactly the 
same substance will produce cholera, yellow fever, &c, at least 
not epidemically ; then we must have different qualities of ozone, 



28 EPIDEMIC CHOLERA. 

or a new principle in the air we breathe, and its presentation, 
in a practical view, is worth little or nothing. But admit that 
there is one poison only, and that that is ozone, how will this 
quadrate with what we so clearly see, that divers seasons, 
years, and terms of years, have always, as in the time of Sy- 
denham, Lancise, and Rush, presented to our notice intermit- 
tent, remittent, typhus, and yellow fever, so variant, that 
almost every epidemic requires some alteration in our plans of 
treatment. 

Much opportunity for observation in different parts of our 
country, with an eye, we think, never blinded by prejudice, 
has wedded us more and more to the views of Sydenham, when 
he says, "This I am sure of by many observations, that the 
above-mentioned diseases, especially fevers, do very much 
differ ; for that method which is successful one year may, 
perhaps, prove destructive another." "I perceive that years 
that agree as to the manifest temperature of the air, are in- 
fested with various diseases." "And thus it happens that 
there are many constitutions of years that arise neither from 
heat, nor cold, nor moisture, nor drought. The air is contami- 
nated with effluvia as dispose to this or that disease, as long as 
that constitution prevails." "Every one of these constitutions 
is accompanied with a fever proper and peculiar to itself." 
" There are diseases which, though they be epidemic, yet are 
they so irregular that they cannot be comprehended under any 
one form, and are indeed ill-conditioned." "Diseases may 
vary in one and the same constitution, which is of so great con- 
sequence, that the curative indications are to be omitted or 
used according as the disease is disposed." "Where many 
diseases infest one year, one is more predominant, and all the 
rest are, as it were, under it, and don't rage so much at that 
time." "Diseases which have been called putrid, malignant, 
spotted, and the like, ought rather to be named after the con- 
stitution." This leads to the important conclusion, that since 
cholera has infested our country, from point to point, that 
there has been a choleraic constitution existing since the year 
1832 ; and hence we derive the opinion, that our diseases, 
though somewhat erratic, are ruled more or less by a choleraic 



FOMES OF CHOLERA AS AN ANTECEDENT CAUSE. 29 

foraes, or perhaps an occult principle. We shall show, as we 
proceed, that it appears in forms which may be properly called 
cholerine and cholero-dysentery, and malignant cholera, or 
rather cholera lethalis ; but we mean by these terms one and 
the same morbid influence, differing in force, and the stage of 
the disease, each form or stage having its own peculiar symp- 
toms ; all which we shall endeavor to point out and illustrate in 
these sheets. Our notice of the epidemic of 1804 will be ex- 
tended. 



FOMES OF CHOLERA AS AN ANTECEDENT CAUSE. 

The fomes of cholera shows itself now here now there, pre- 
senting, unfortunately, a diversity of character which renders 
it difficult to adopt a successful practice ; but we believe there 
is but one governing principle. A great desideratum is gained 
if we can satisfy ourselves that one of the most characteristic 
features of this disease is that it appears in hundreds of cases 
of cholerine and cholero-dysentery, where we see one terminate 
in the malignant form. A proper understanding of this part 
of our subject would relieve the public mind from the horror 
and fear that attends outbreaks of the disease in its aggravated 
form. And it ought not to be lost sight of, that if many have 
fallen victims to epidemic cholera, many of these would have 
died of other diseases, especially bilious fevers, since cholera 
prevails most in locations where such fevers usually exist in 
the summer and autumnal seasons. There is good reason to be- 
lieve that cholera is but a misplaced bilious fever, according to 
Dr. Rush ; or according to Dr. Sydenham, " a fever turned in- 
wards (and to use his own words) upon the guts," and one in 
which there is not present the "symptoms proper to the 
disease." 

Cholera, doubtless, makes its inroads upon the chylopoietic 
viscera, and exerts especial force on the alimentary tube ; here 
it incubates, and, we believe, in many cases for long periods, 
crippling the digestive functions first, and oftentimes passing 
away unknown, where there is great regularity of living in all 
respects ; in other cases, giving rise to more or less diarrhoea, 



30 EPIDEMIC CHOLERA. 

sick stomach, flatulency, &c, and is now easily cured. We are 
here reminded of an observation of Richerand, who says, that 
"man, in the abstract, may be considered a tube, open at both 
ends." It is clearly the laboratory of the supplies of life, and 
it may readily be believed that when this laboratory is laid 
waste, or all its fixtures tarnished, cracked, and broken, un- 
wonted products will accumulate, and break up the works that 
are proper and necessary to be done. A healthy economy 
carries things onwards, and proper supplies are carried to their 
several destinations ; but arrested as they now are, abnormal 
changes take place, and, while appalling sufferings are going 
on, destruction of the vital fluids and of their associated senso- 
rial agents, comes over its victim, and the deadly work is 
finished by a retrograde movement of the impaired blood, and 
other plastic fluids, into the great tube of life ; and as the 
serum of the blood pours into the bowels, there now comes to 
the aid of the morbid train endosmose and exosmose, to aid in 
pouring out the plastic serum, we believe, throughout all the 
tissues. This is the most common state of things; but it must 
be admitted other changes take place, and death becomes en- 
throned in the brain. Or we have killing spasms, or conges- 
tion, or collapse of the brain, or polypous concretions take place 
in the blood, especially in the heart, also carbonization of the 
blood in the arteries, &c, besides urea in the blood. 

Hoping that we have made ourselves understood in our ob- 
servations and views respecting epidemic cholera, and thereby 
removed some error, and doubts, and uncertainty, as respects 
the character of the disease, and also disabused the public 
mind of the common error of looking upon it as contagious, we 
now enter more practically upon the disease in its clinical 



CHOLERA AS SEEN AT HAMBURG. 

In the year 1832, we published a third volume of a medical 
journal at Baltimore. In the number for July of that year, 
we made the following communication : 

Our readers will recollect that we have, in our preceding 



CHOLERA AS SEEN AT HAMBURG. 31 

volumes, afforded information, from time to time, concerning 
this wide-spread and alarming disease. The disease continuing 
its ravages, and having, in its course, advanced nearer and 
nearer to us for the last two years, too much pains cannot be 
bestowed on this momentous subject. We have not met with 
anything which has lessened our confidence in the opinion 
most generally entertained by the profession in Europe at this 
time, and which we have been endeavoring, with some of the 
most able of the profession in this country, to establish, i. e., 
the non-contagiousness of cholera. But, notwithstanding the 
settled conviction of ourselves and many others, still there 
are many of the profession, but especially there is a large por- 
tion of the people, in Europe and this country, who believe the 
disease to be contagious. Such being the state of things, it 
seems meet that we continue to add a few more important 
items of information from abroad, with a view of more gene- 
rally and firmly establishing the opinion which we believe to be 
incontrovertible, viz., that the disease, known by the name of 
Asiatic or Russian cholera, is not contagious, nor can it be 
arrested in its career by quarantine or sanitary cordons. 

Since our last publication on this subject, we have received 
important information from different quarters. The most sa- 
tisfactory account which we have received, as regards the cause 
and the symptoms of the disease, is contained in a pamphlet, 
forwarded to us, some time since, by our friend and correspon- 
dent, Dr. Fricke, of Hamburg. 

It is said that, at a time when there was no cholera known 
to exist within thirty miles of Hamburg, it suddenly made its 
appearance, in the beginning of October, 1831. Its approach 
towards the city was anticipated by the medical public, and 
precautionary measures were adopted to prevent its occurrence. 
Indeed, the cool and unprejudiced observer, says our author, 
had for months perceived a resemblance in the diseases which 
existed then at Hamburg, and those which had always preceded 
cholera in neighboring towns. In answer to the question, 
How did the disease originate at Hamburg ? Dr. Fricke says, 
it is only necessary to examine the contents of the pamphlet 
before us, to be satisfied that cholera is not contagious. 



32 EPIDEMIC CHOLERA. 

There is appended to the pamphlet a ground-plan of Ham- 
burg, with the names of all the streets, courts, walks, &c. By 
this plan it appears that the disease, which set in about the 
first of October, existed in nearly one hundred streets within 
that month. The first cases were remote from the wharves, 
and no disease existed at the wharves, except the case of 
one man, about the 10th of October, who had no communica- 
tion whatever with the land, till he was removed to the hospi- 
tal ; already containing several patients affected with cholera. 

We are reminded that the cholera broke out at Dantzic 
about the 29th of May, 1831 ; at Riga, about the 25th of the 
same month; at St. Petersburg, about the 29th of June; at 
Konigsburg about the 22d of July. In consequence of the 
approach of the disease, thus clearly manifested, the senate of 
Hamburg resolved to do everything in their power to prevent 
the arrival of the disease in their city. The disease still ap- 
proached, and was soon at Berlin. At this early period, mea- 
sures were adopted to establish a rigid quarantine at Ham- 
burg against such places as were affected with the disease. 
About the 10th of September, a quarantine was established, 
which prohibited all ships from entering the port without clean 
bills of health. 

So apprehensive were the city authorities of the entrance 
of the cholera, that, as early as the 30th of July, there was a 
town meeting among the city officers, at which was organized a 
general health commission, consisting of a certain number of 
the senators, physicians, surgeons, and apothecaries. The 
general health commission was made to consist of four mem- 
bers of the senate, two physicians, one surgeon, two apothe- 
caries, and four burghers, with two citizens from the suburbs, 
and an assistant body composed of an equal number of profes- 
sional men; the whole constituting a body of about thirty of 
the most respectable and intelligent men in Hamburg. 

Among their early measures, in addition to their establish- 
ing a quarantine, and other restrictive measures, they provided 
hospitals in anticipation, in which were provided two hundred 
beds, physicians were appointed, and all necessary officers and 



CHOLERA AS SEEN AT HAMBURG. 33 

servants ; and it was made the duty of the citizens, having 
cholera in their houses, to put out a label, upon which was 
written "Cholera." 

The following brief abstract of the meteorological observa- 
tions may not be uninteresting. If we take into the account 
the months of May, June, July, August, and September, the 
year 1831 (the year of cholera) was warmer than the pre- 
ceding year, and warmer than usual. The thermometer rose 
in '31 to 20° R. on fifty-two days; in the year '30 but twenty- 
seven times. The mean temperature for '31 was 13° 38' ; that 
for '30 was 12° 09'. The temperature was suddenly reduced 
in September. The barometer ranged higher in '31 than in the 
preceding year. The hygrometer ranged higher in 1831 than 
in 1830. There were more clear days in the year 1831 than in 
the year before ; and, leaving September out of the account, 
more than common. In 1830, there were 101 rainy days ; in 
1831 there were but 82. The wind was much more frequently • 
from the east in 1831 than in the preceding year ; it was sel- 
dom west, which is ordinarily the prevailing wind. 



POPULATION OF HAMBURG. 

Hamburg contains 120,000 inhabitants, of which the stran- 
gers and military make one thousand. There are about 8,500 
houses, besides a large number of halls and small dwellings 
(booths), and 18,000 inhabited cellars. Many of the poor in 
Hamburg live in narrow passes, that are damp and filthy ; and 
many of those who inhabit these places never see the sun, 
except they leave their dwellings. There are many who live 
in wider streets, but in deep cellars, which are damp or wet ; 
these two classes make from thirty to forty thousand persons, 
besides which there are about six or seven thousand paupers. 
These cellars are liable, two or three times a year, to be filled 
with water by the rising of the Elbe — the water remains usually 
six or eight hours, after which the inhabitants clear out the 
cellars as well as they can, and move into them before dried ; 
and yet it is known that people have inhabited these cellars 
3 



34 EPIDEMIC CHOLERA. 

for two or three generations, and many of them have arrived 
at great ages. 

Dr. Fricke has given an abstract of the deaths for ten years 
preceding that in which the cholera made its appearance ; by 
this abstract it appears that the mortality had been on the in- 
crease for some years preceding the existence of cholera. In 
the year 1830 there were 5350 deaths, and but 4,582 births, 
making a difference on the side of mortality of 758. It is not 
a little remarkable that, in the month of September, 1830, 
there were seventy -two deaths by consumption, while in 1831 
there were but six during that month. And in the month of 
October, 1831, while the cholera was raging there, but twenty- 
eight cases of consumption occurring, while in the same month 
of the preceding year there were forty-two deaths from that 



The first case of cholera that was known to occur in Ham- 
burg, was on the 6th of October, 1831, and it appears that, 
on that day, there was but one case. The highest, up to the 
15th, was fifteen ; and the total for those fifteen days was fifty- 
two. A seaman died on shipboard, at quarantine, on the 2d 
of October. He had been affected with chronic diarrhoea, but 
died without vomiting or fever. There were no pains in the 
abdomen, nor was there headach. The body, being dissected 
by a council of physicians and surgeons, they gave as their 
opinion, that this was not a case of cholera. The ship, having 
made out her quarantine, lay harmless at the lower harbor. 



ANNOUNCEMENT OF CHOLERA AT HAMBURG. 

First Report. — The public surgeon, Hauptfleish, on the 
evening of the 6th of October, 1831, reported to the autho- 
rities the following information : " To-day, at noon, I was 
called to a deep cellar, to see a sick man, named Peter Peter- 
son, 67 years of age, and, according to the report of Johanna 
Ohleus, Peterson had been in her cellar on the 5th of October, 
and drank a great quantity of sour milk, and afterwards drank 
several drams; and he was a free drinker of ardent spirits. 



ANNOUNCEMENT OP CHOLERA AT HAMBURG. 35 

On the 5th of October, three-quarters of an hour after ten 
o'clock, this man was overtaken with violent vomiting and 
purging, which continued very violent till half-past two in the 
night ; after which it was somewhat abated, till six in the 
morning. The patient was now greatly reduced and broken 
down, but still conscious. I forthwith applied remedies, but 
without effect. The patient grew constantly weaker, the 
breathing rattling, the extremities as cold as ice, the hands and 
feet blue, the eyes sunken in. These symptoms were accompa- 
nied with an intermitting pulse, and cramps in the extremities. 
He died at six o'clock. The body was immediately taken to 
the dead-room at the Curhaus. On the 7th of October, the 
body was inspected, and the muscles were found hard and stiff, 
and there were bluish spots on the hands and feet, which 
rapidly changed to black. Inquiry instituted, to ascertain the 
habits of Peterson, went to prove that, as before stated, he 
had been living about four months in a deep cellar, and was a 
free user of strong drink. For the last twenty weeks, he had 
not been out of Hamburg. On the 5th of October, he had 
been at two places, but had no intercourse with strange seamen, 
or other strangers. He had not visited any water-craft, except 
at the wood-bridge and brook-bridge, where he witnessed the 
landing of fish and potatoes. The deep cellar in which he 
died was situate No. 30 Nicolai Street, running from east to 
west, about eight hundred feet from the wharf, on the evening 
side, not narrow, but wide and high. There was a great 
number of beds crowded in the apartments of this extensive 
cellar. Forty persons, of different occupations, tenanted the 
apartments, at the time under notice. On the 11th of October, 
these persons, with others, amounting to 85, were removed to 
a better location, at the expense of the city, and kept under 
guard. 

Second Report. — On the 7th of October, the city physician 
found a woman, named Maria Dorothy Beckman, aged 28 
years, sick in bed. The disease had made its appearance half 
an hour before he saw her — giddiness, pulse very small, face 
pale, and the extremities pretty cold. Dr. Hauptfleish ordered 
such internal remedies as he judged proper, and spirituous 



36 EPIDEMIC CHOLERA. 

rubbings. At a second visit, the extremities were as cold as 
ice, the eyes sunken, and the pulse scarcely to be felt; severe 
cramps. At six o'clock, there seemed to be some amendment ; 
the pulse more perceptible; but at ten o'clock she was worse : 
the hands and feet blue, the eyes are sinking in deeply. Half 
past twelve o'clock at night, patient had convulsions, which 
lasted in the toes (cramps, we suppose) for more than an hour, 
when she died. She had been extremely intemperate, but had 
not been out of the cellar for twelve weeks preceding her 
attack, except once a little way into the country, to dig pota- 
toes, which was on the 5th of October. 

Third Report. — While Dr. Schleiden was attending the 
above case, a man came to his notice — a notorious drunkard, 
Wm. Summers, aged 37, a native of London. He complained 
of pains in the breast, giddiness, heaviness at the stomach, 
with convulsions. An emetic was given, after which Drs. 
Schleiden and Hauptfleish employed venesection, blisters, 
leeches, rubbings, &c. During this day, the symptoms seemed 
to abate. On the next morning, the symptoms were worse, in 
consequence of his having drank a large quantity of ardent 
spirits; the face now Hippocratic, pulse scarely perceptible, 
voice weak and hoarse. He was taken to the Hornwerk Hos- 
pital, where he died the next day. It was ascertained that he 
had not been out of the cellar for four weeks. The night that 
Peterson died, he paid him some attention, and slept with him. 

Some time after the above reports were made, Dr. Bucheister, 
physician to the Hornwerk Hospital, represented as follows : 
" I found, on the 9th of October, at the time I took charge of 
the cholera patients, at the Hornwerk Hospital, a man who 
had sickened on the 7th, in Nicolai Street, in a deep cellar. 
This patient had been much benefited by bloodletting, frictions, 
opium, and camphor, &c, but was now growing worse. The 
entire skin was cold, the eyes sunken, the aspect of the face 
greatly anxious, the tongue covered slightly, great desire for 
cold drinks, the pulse scarcely perceptible, vomiting and purging 
of thin, whitish matter, cramps in the legs. Brisk rubbing 
with rum ; and cold water, with a little wine, was directed in 
small portions. The following prescription, of which a table- 



ANNOUNCEMENT OF CHOLERA AT HAMBURG. 37 

spoonful was to be given every hour: B. — Infus. Mentli. pip., 
sviii. ; ad liq. laud. Sydenham, gtt. lx.; liq. Hoffm. sij. : misce. 
His abdomen had been blistered. He slept some during the 
night, but vomited and purged twice. In the morning, the 
anxiety was much abated, the skin is something warmer, the 
tongue is coated brown, the voice weaker and hoarser, thirst 
great. Proceed with the medicine, and give, for drink, thin 
mucilage of salep, with a little red wine. 

On the 10th, the patient vomited once more, and the scene 
became changed. He was restless, talked now English now 
German, lost his physical powers, and talked incoherently, and 
strove to get out of bed ; the tongue moist, thirst abated, the 
body warm, no vomiting or purging, slight cramps and con- 
vulsions, pulse quick and small, eyes glistening, appearance of 
typhus versatilis. Mustard was applied to the calves, and there 
was directed the following : R. — Camphor, gr. xxxi. ; gum 
Arabic, q. s. ; aq. menth. ^vj. Misce; table-spoonful every 
hour. He died at midnight. 

Dissection. — The eyes deeply sunk in their sockets, and 
turned upwards ; appearance of despair ; extremities con- 
tracted. Two inches above the hands was bluish red. On 
cutting open the belly, there was considerable serous discharge. 
The stomach distended, and one of its coats slightly reddish, 
covered with whitish slime ; the liver outwardly whitish ; upon 
cutting into it, found much venous blood. Gall-bladder much 
distended with yellow-greenish bile ; the outer coat of the in- 
testines slightly red, covered with whitish-brown matter, much 
of which lay in the colon. The bladder was firmly drawn 
together, and empty; in the aorta and vena cava, venous blood. 
The brachial arteries empty ; the radial was filled with coagu- 
lated, tar-like blood. 

Fourth Report. — On the 8th of October, a man named Adam 
Heuer, who lived 3500 feet from the wharf, had died suddenly 
that morning. This man had been attacked in the night, and 
complained of stricture at the breast, and had great thirst. 
He drank a great quantity of cold water, afterwards some 
warm beer. Soon after this, severe vomiting and purging 
came on, to which was soon added strong cramps at 8 o'clock 



38 EPIDEMIC CHOLERA. 

in the morning; soon afterwards, the body was found, yet warm, 
on the floor ; the eyes deeply fallen in, the lids livid, the ex- 
tremities and joints generally stiff. The muscles of the thighs, 
particularly the vasti and rectus femoris, moved themselves, a 
short time after death, with spasmodic movements. The report 
of this case induced Dr. Dammart, a senator, to call together 
the city authorities and physicians, to witness the dissection of 
Beckman and Heuer. 

REPORT OF DISSECTIONS AT HAMBURG. 

Saturday, 8th October, 1831, a meeting took place for the 
purpose of witnessing the dissection of the body of the woman 
Beckman. The body well-formed, denoting strength, legs 
livid, extremities stiff, the fingers bent into the hands, nails 
blue, gangrenous spots on the arms, back, and other parts, the 
eyes half open, pupils moderately open, face marbled with 
lividness. 

Opening of the Head. — The dura mater was bluish, and 
much turgid with blood ; the falciform process was attached to 
both lobes of the brain, — the pia mater had a whitish matter 
weeping from about the crown of the head ; the veins were much 
filled ; the brain itself was full of blood ; the more internal parts 
of it less turgid with blood. In the ventricles there was a lit- 
tle yellowish serum ; the plexus choroides was filled with dark 
blood. The lower surface of the brain, and for some distance 
into its substance was a little red ; the cerebellum a little soft- 
ened — on the bottom of the skull was seen some bloody water, 
that seemed to come from the spinal canal. 

Opening of the Thorax. — The lungs, when looked upon, or 
cut, were healthy and bloodless, and without adhesions — in the 
pericardium was found a little serum ; the auricles of the 
heart bluish and distended ; in the left ventricle a little dark 
blood ; the right crowded ivith very dark blood ; the aorta much 
distended tuith very dark blood ; the supplying veins empty ; 
no polypous concretions. 

Opening of the Abdomen. — The omentum was moderately 
red, as also the outer coat of the intestines. The larger in- 



REPORT OF THE DISSECTIONS AT HAMBURG. 39 

testines of a whitish color ; the gall-bladder well filled with 
reddish slime. The bladder empty and contracted ; spleen 
normal ; the liver somewhat softened and pale ; the stomach 
outwardly whitish, inwardly its entire coat was covered with 
blackish, thin slime, which commenced distinctly from the 
duodenum, where there was an ecchymosis ; the small glandular 
bodies of the abdomen appeared normal ; the caecum was filled 
with a whitish mass of an opaline appearance, which, upon open- 
ing the part, assumed a chocolate color ; the gall-bladder well 
filled with healthy bile ; the small intestines contained a thin 
fluid, not unlike rice-water, but a little reddish — the inner coat 
of the intestines was generally red. 

Question put to the Physicians by the Health Commission, 
who were sitting on the case above noticed. — Is this case, so far 
as may be inferred from what has been presented, Asiatic 
cholera ? Answers in the affirmative by Doctors Schleiden, 
Ebeling, Fricke, Kunhart, Gerson, Chaufepe, Sen., Zanck, 
Sandtman, Homan, Zimmerman, Nagel, Gunther, Oppenheim, 
Bucheister, Baecke, Trier, Kulensmidt, Bernhardt, Haupt- 
fleish, Deidricks. We have the pleasure of knowing personally 
most of the gentlemen whose names appear in the above, list, 
and know them to be men of eminence in their profession. 
Without disparagement to the other gentlemen, we wish espe- 
cially to notice the suavity of manner of the good and gifted 
Chaufepe, who has been styled the "Rush of Hamburg." It 
may be observed, that there were twenty members in the above 
board ; and it was a noble instance of devotion for the benefit 
of mankind; for, we have no doubt the majority of them, at 
that time, were believers in the contagiousness of cholera. 
By their noble, and we may say disinterested exposure to the 
effluvium of the body, for such they believed to exist, at that 
time, they gave an important instance of much exposure, with- 
out catching any disease. We had the satisfaction, the year 
before the cholera occurred in Hamburg, to read before those 
gentlemen and many others, a memoir to prove the non- 
contagious nature of yellow fever, for which we received a 
unanimous vote of thanks, and, we hope, made a good many 



40 EPIDEMIC CHOLERA. 

converts to our opinion, which probably led to ready conversion 
in respect to the non-contagiousness of cholera. 

Dissection of the body of Heuer, whose disease and death 
has already been noticed. — Robust, above middle size, and 
muscular; extremities stiff, but not livid; the skin on some of 
the fingers was drawn in; the scrotum and penis livid, gangre- 
nous spots on the back. Opening of the Head. — The dura 
mater and brain turgid with blood, and some adhesions of the 
membrane to the brain ; the substance internally not injected 
with blood ; a little water in the ventricles ; the plexus cho- 
roides not injected, nor was there any blood at the base of the 
brain ; the sinuses of the brain filled with thin grumous blood ; 
the cerebellum sound. 

Opening of the Thorax. — Adhesion of the right lung, both 
lobes much injected with blood ; in the pericardium a little 
watery fluid ; the left ventricle of the heart filled with dark 
blood, the right quite full. The aorta slightly filled with blood, 
the great veins empty. 

Opening of the Abdomen. — The omentum pretty sound, not 
reddish ; the blind gut distended, and contained a fluid resem- 
bling rice-water; it was neither whitish nor reddened, but 
marked with spots. The inner coat of the intestines a little 
reddened, and filled here and there with a reddish fluid. The 
stomach was much distended, and contained a portion of fluid 
resembling beer ; liver sound ; the gall-bladder filled with a 
very dark fluid ; some mucus in the duodenum ; the bladder 
empty and very closely contracted. 

PROCEEDINGS OF HEALTH COMMISSION. 

Question by the Commission. — Was this also a case of 
cholera ? The question was again answered affirmatively by 
Drs. Schrbdter, Schleiden, Fricke, Kunhardt, Chaufepe, Sen., 
Zanck, Homan, Sen., Zimmerman, Gerson, Sandtman, H.Nagel, 
Kulensmidt, Gunther, J. E. Bucheister, Trier, Hauptman, Bern- 
hardt, and Diedricks. Upon the delivery of this record and 
account of the dissections to his Excellency Burgomeister Dr. 
Bartels, President of the Commission, notice was given to his 



PROCEEDINGS OF HEALTH COMMISSION. 41 

Magnificence, the President of the Senate, Dr. Abenroth, 
through whom the Senate was convened the same night. The 
Health Commission assembled with the Senate, and sat till after 
midnight, when they made known that, whereas, it appears by 
three authenticated cases, and two dissections of dead bodies, 
and most of the physicians and experienced persons, who had 
knowledge of the facts, being of the opinion that these were 
cases of the cholera, it becomes the duty of an elevated Senate 
to make public such facts, and to forbid the issuing of clean 
bills of health, to make known the same, and, as suspicious 
cases may arise, make them also known, so that all circum- 
stances, subservient to the end in view, be made known. Dated 
at the Senate Chamber, at Hamburg, October 9th, 1831. The 
Senate directed the Health Commission to do everything ne- 
cessary in fitting up hospitals, &c. 

On the 8th of October, Dr. Stamman reported the case of a 
woman, who was seized at six o'clock in the morning, and died 
at three o'clock in the afternoon; the principal symptoms were 
cramp of the stomach and diarrhoea. 

Sixth Report. — John Classen, a paver, who lived 2500 feet 
from the wharf, died suddenly on the 8th of October. The 
body was sent to the Hospital Ericus, and Dr. Siemsen, Hospi- 
tal Physician, gave the following account of the dissection. 
Outward appearance of the Body. — The face somewhat livid; 
the eyes much sunken ; the nose pointed ; the extremities livid; 
the hands spasmodically drawn in ; hands and feet wrinkled ; 
age between forty and fifty. Opening of the Thorax. — The 
lungs presented adhesions ; their substance normal and not 
much injected with blood ; the outer covering of the heart (peri- 
cardium, we suppose) livid ; the veins, particularly the great 
veins, were turgid with blood ; in both ventricles black fluid 
blood. Opening of the Abdomen. — The substance of the liver 
very firm ; upon cutting into its covering, much clammy, black 
blood escaped upon pressure; the spleen very soft ; the stomach 
outside somewhat reddish, the inside covered with a greenish 
mucus ; the vessels of the intestines, particularly those of the 
duodenum, remarkably conspicuous ; a quantity of yellowish 
gray substance in the intestines. Contents of the gall-bladder. — 



42 EPIDEMIC CHOLERA. 

Blackish-green and thin ; about eight ounces of dark-greenish 
fluid mixed with shreds of lymph ; kidneys turgid with blood ; 
the bladder closely contracted and corrugated ; some whey- 
like urine. 

Seventh Report. — On the 9th of October, there came into 
the fever department, a woman who had been seized with the 
disease the day preceding. Purging and vomiting were already 
severe, with violent spasms; the skin as cold as ice; anxiety 
great; great restlessness; pulse very small, at times imper- 
ceptible ; great thirst, particularly for warm drink. Frictions 
were applied, but seemed to increase the spasms, and had to 
be left off. A large orifice in the arm afforded a few drops of 
tar-like blood, after which she was immediately put into a 
warm bath, when the blood began to flow, till she lost about 
ten ounces during ten minutes that she was in the bath ; soon 
after taken out of the bath, the spasms became extremely vio- 
lent. About midnight she was suddenly overspread with a 
warm perspiration, which did not last long. In the morning 
the body was as cold as ice, the anxiety great, and she was 
again overtaken with vomiting and purging. She died after 
having severe spasms. 

Eighth Report. — Dr. Bucheister reports the case of C. J. 
Sieman, aged forty-three, laborer, a great drunkard. He was 
seized on the 8th of October, at one o'clock. He had had a 
number of evacuations, upwards and downwards, before admis- 
sion. The heat of the skin not quite extinguished ; an eruption 
appeared over the whole body resembling petechia. He was 
immediately put into a warm bath, where he was well rubbed, 
and remained in ten minutes, after which he felt better. An 
infusion of peppermint and laudanum was given every hour. 
On the 10th, the skin warm and perspiring ; the head red and 
hot ; the eyes much reddened, restless with delirium ; pulse 
full, but not hard ; bled to ten ounces ; the blood clear, and 
flowed in a stream. An hour afterwards there were strong 
symptoms of oppression of the brain; twelve leeches to the 
temples ; sinapisms to the calves ; every hour two grains of 
calomel ; cold applications to the head. 11th. Took fifteen 
grains of calomel ; rested well ; the face red and covered with 
sweat; the tongue somewhat coated, moist and warm; eyes 



PROCEEDINGS OF HEALTH COMMISSION. 43 

less glassy; heat of skin natural; more rational; the pulse 
small ; no purging nor vomiting, no spasms ; urine red and 
clear, passed about six ounces ; no pain in abdomen. Continue 
cold applications to the head ; prescribed 1 gr. of calomel and 
5 grs. of sugar of milk every hour. In the evening there were 
appearances of congestion of the head ; slight wanderings, so 
that he loses himself when speaking. Twelve o'clock at night, 
directed twelve leeches to the head. October 12th. Has slept 
some last night ; the skin natural in temperature ; pulse small ; 
he is more rational ; has had three passages of brownish mat- 
ter ; the region of the liver painful ; tongue red, hard and dry ; 
continue the cold application to the head. Give \ grain of 
camphor and 5 grains of sugar of milk every hour. Sago with 
wine allowed. In the evening the temperature good ; pulse 
small ; tongue whitish ; mind disturbed ; conscious when 
spoken to ; sinapisms to the calves. On the 13th, in the morn- 
ing; he was restless last night, and talked incessantly, and 
struggled to get out of bed ; pulse small ; temperature good ; 
had several brownish, thin passages ; tongue coated yellow ; 
continue the 5 grain doses of sugar of milk and \ grain doses 
of opium every two hours ; cold applications to the head. In 
the evening he is much worse ; delirium greater ; is weaker ; 
pupils contracted to a mere point ; temperature reduced ; twelve 
leeches to the head ; sinapisms to the calves ; an hour after- 
wards 6 grains of musk with 2 of opium ; after lying a little 
while quiet, he died in dreadful convulsions at twelve o'clock 
at night. 

We may observe, in the foregoing report, that this patient 
was treated more actively than any of those reported at Ham- 
burg ; but the active remedies, as bleeding to ten ounces, two 
grains of calomel every two hours, and cold applications to the 
head, were not employed till the third day of the illness ; and 
the five grain dose of calomel not till the fourth day ; the first 
twelve leeches on the fifth day ; sixth day, twelve leeches were 
applied to the head, also ice. Sugar of milk I where is thy 
potency ? It is evident that the more active measures in this 
case were so much out of time as to render them hurtful, in- 
stead of adjuvant. Besides, we would remind the reader of 



44 EPIDEMIC CHOLERA. 

the patient's drunken habits, which unfitted him for rapid or 
considerable depletion. It is highly probable that this man 
would have died under any treatment ; but the duration of 
the case was unusual, and depletion, more timeously applied, 
might possibly have afforded a different termination. 

Ninth Report* — On board a ship, which left Bahia on the 
16th of July, 1831, P. Engelund, a seaman, was affected with 
slight diarrhoea from the 1st to the 10th of October, which in- 
creased for want of care. This ship had not touched at any 
port since leaving Bahia till she arrived at Hamburg on the 
14th of September. He drank, while on board, freely of fresh 
beer. On the 8th of October, at night, the spasms were so 
violent that his comrades remained with him. On the 10th, 
he was taken to the cholera hospital. None of the ship's crew, 
excepting the captain, had any communication, direct or in- 
direct, with the land, till the 11th of October, some days after 
this disease prevailed in streets, in cellars, and narrow passes, 
quite remote from the ship. 

On the 20th of October, Ollef Sermonius was taken from the 
same ship, sick of cholera, to the hospital. On the 22d and 
23d, two other sailors on board were affected with cholera, 
but were cured on board the ship. This day, the 31st of Oc- 
tober, the whole crew are in health. 

Dr. Bucheimer reports the case of Engelund thus : Has 
been affected eight days with diarrhoea, to which were added, 
the day before his admission, vomiting and spasms. The mat- 
ter evacuated resembles rice-water ; cramps in the feet ; great 
thirst and anxiety ; pulse small ; temperature moderate. He 
was immediately put into a warm bath, and was well rubbed 
while in ; after the bath he felt very ill ; severe spasms and 
vomiting. Infusion of peppermint and laudanum, and sulph. 
ether were given ; twelve leeches to the scrobiculus cordis. At 
twelve o'clock, the spasms had somewhat abated ; there was a 
gentle warm perspiration over the whole body; the pulse a 
little raised ; tongue slightly coated. In the evening, the tem- 
perature of the skin was diminished ; the vomiting and diarrhoea 
frequent ; rubbing, and warmth, by means of jugs, were directed. 

October 11th, in the morning; he has vomited and purged 



PROCEEDINGS OF HEALTH COMMISSION. 45 

several times. The fluid thrown up resembled camomile tea, 
that from the bowels rice-water ; the extremities were cold, and 
no perspiration ; spasms but seldom ; anxiety not great ; pulse 
not perceptible. Some medicines were directed, which we do 
not deem important ; but in the evening it disagreed with his 
stomach. He now makes no complaint, but lies with his eyes 
half closed, and mouth open; answers sensibly, and has still 
great desire for warm drink. At midnight he had several in- 
voluntary passages from his bowels. 

12th of October, in the morning. He has slept a little during 
the night, and laid still; vomited and purged several times; 
the distress in the precordia not great; spasms not strong; the 
pulse a little raised ; blisters which had been applied drew well. 
In the evening he has vomited and purged once ; pulse small, 
but perceptible. Sago with wine and some camphorated medi- 
cine; blister to the neck was renewed. 13th, morning. Slept 
some last night ; towards morning he vomited some bilious mat- 
ter, and had many thin brownish passages ; the tongue coated 
yellowish ; the temperature natural ; pulse tolerably distinct ; 
no spasms, but frequent eructations ; slight pain in the precor- 
dia. In the evening, congestion of the head ; pulse small ; face 
red ; restlessness ; vertigo ; rather unconscious ; skin cool ; 
twelve leeches to the head-; cold applications with ice to the 
head, and sinapisms to the precordia. 14th, morning. Slept 
well for six hours ; pulse slow; face not red; temperature good ; 
died soon after midnight. 

It seems proper to observe here that in this case, as in all 
those where the more active treatment was employed, this was 
instituted too late. After the blood has settled in a state of 
turgescence in the brain and its membranes, we cannot reason- 
ably expect to overcome this simple congestion by means of 
depletion. We should rather apprehend injurious effects. But 
we believe there is a period when such tendencies may be ar- 
rested by suitable depletion. We shall, however, defer our 
more exact practical views until we come to speak of the disease 
of 1832, in Baltimore, &c. 

The foregoing cases afford us much exact knowledge of the 
symptomatology and of the treatment, which, in confirmed 



46 EPIDEMIC CHOLERA. 

cholera, has been alike unsuccessful in all places, and under 
all treatment. We deem it important to extend our quotations 
through some more dissections, and we may perhaps notice, as 
we proceed, some remarkable symptoms and other matters. 

Case of Frederick Wagner, a laborer, twenty-four years of 
age, who died of cholera, and of whose body it is said, it pre- 
sented outwardly the habitus cholericus. Opening of the head. 
— Vessels of the dura mater much filled with venous blood ; 
bloody points through the brain, and its substance somewhat 
watery. The cerebellum surcharged with blood, and was red ; 
arbor vitse turgid with blood ; bloody serum flowed from the 
spine, upon removing the brain. Opening of the thorax. — The 
right lobe of the lungs had been diseased, the left was healthy; 
the ventricles of the heart, particularly the right, turgid with 
dark blood. In the aorta were polypous masses. Opening of 
the abdomen. — The liver had a stony concrete on its surface, 
otherwise it appeared to be sound; gall-bladder not much 
charged with bile ; bladder contracted, small and corrugated ; 
peritoneal covering of the stomach of a rose-red color ; mucous 
coat covered with a greenish fluid ; intestines on the inner sur- 
face reddish, and some reddish fluid in their canal. 

Specimen Case of Cholera. — The following case is so 
strongly marked by symptoms of malignancy, and is what 
may be termed a fully portrayed case of cholera, that we pre- 
sent it as a perfect specimen of that disease. 

Anna Garrasen, an inhabitant of a deep cellar, thirty-five 
years of age, of dissolute habits. She sickened on the 10th of 
October, and was taken to the hospital. The day before her 
attack she was quite well, and slept well the night before. The 
attack commenced with violent vomiting and purging, and 
violent pains in the belly. When she arrived at the hospital, 
the whole body and tongue were ice-cold ; the face looked as 
if frozen ; the hands blue with cold ; eyes deeply sunken in ; 
tongue coated white, but moist; pulse imperceptible; the 
purging and vomiting continues severe, and the discharges 
colorless, thin fluid ; great anxiety ; violent cramps, worst in 
the feet ; precordia in great distress, worst towards the back. 
We shall not notice the treatment further than to say, she was 



REPORTS OF DISSECTIONS. 47 

put into an alcoholic bath, at 45° R., where she remained 
twenty-five minutes, and felt better ; the surface became warm 
again and moist. An hour after this, she presented the aspect 
of a person in typhus fever, and death came to her relief thirty- 
three or thirty-four hours after the seizure. 

Dissection of the body. — The face much fallen in ; eyes 
drawn upwards ; abdomen much swelled ; extremities drawn ; 
hands and fingers of a livid color. Opening of the head. — 
Upon cutting into the coverings of the brain, there appeared 
much venous blood; dura mater injected and dark; much 
blood flowed upon cutting into the substance of the brain; ven- 
tricles filled with clear serum ; also the third and fourth ven- 
tricles. Opening of the thorax. — Except some adhesions, the 
lungs were sound, the heart large and soft. Opening of the 
abdomen. — The surface of the liver pale, substance of it not 
much charged with carbon ; the gall-bladder filled with yel- 
lowish bile ; some reddish spots in the stomach ; one ulceration 
in the intestines ; serum quite full of whitish matter ; aorta 
and vena cava filled with carbonized blood ; bladder contracted. 

A man named Wittchief, fifty-three years of age, died of 
cholera, after a few hours' illness. Dissection. — The eyes 
much retracted ; skin on the hands and feet much wrinkled ; 
the former drawn in and locked ; the latter also contracted. 
Opening of the head. — The dura mater was closely adherent to 
the skull; the brain softened, but not injected. In the left 
ventricle some watery fluid ; plexus choroides was turgid with 
blood ; cerebellum soft and injected; some bloody serum flowed 
from the spinal canal. Opening of the chest. — The left ven- 
tricle of the heart was filled with thin, black blood ; in the 
right ventricle was seen a polypus ; the aorta contained a dark, 
blackish blood. Opening of the abdomen. — The liver was out- 
wardly red ; its parenchyma filled with dark blood ; kidneys in- 
jected; bladder closely contracted, and full of muddy urine; 
the inner coat secreting foreign matter ; serous coat of the 
stomach was reddened ; the inner coat of the intestines appa- 
rently normal; gall-bladder filled with dark bile; spleen in- 
jected, and had some adhesions. 

A man named Neuter, aged fifty-three, lived in a deep cel- 
lar, sickened on the 11th October, and died on the 13th. 



48 EPIDEMIC CHOLERA. 

Dissection. — Outward appearance : fingers locked inward ; 
muscles of the arms contracted ; lower extremities bent inward ; 
hands livid; head turned backward. Opening of the head. — 
Upon opening the head, there was a mass of thick blood, 
and the vessels of the brain were turgid with blood ; dura 
mater strongly attached to the skull ; through the brain was 
seen a serous fluid ; ventricles filled with serum, and a little 
serous fluid flowed out of the spinal canal. Opening of the 
chest. — Lungs injected with carbonized blood ; heart attached 
to the pericardium, not a drop of moisture in it ; heart flabby ; 
left ventricle quite empty, the right well filled ; in the ascend- 
ing aorta much dark blood. Opening of the abdomen.- — The 
intestines appeared in a contracted condition ; liver pale, but 
inwardly full of venous blood ; intestines outside slightly red- 
dish; the stomach contained a brownish fluid; the mucous 
coat here and there reddened ; bilious matter in the small ii> 
testines ; below thinner, and of a feculent smell ; bladder 
closely contracted ; kidneys turgid with venous blood ; also the 
crural artery, and the descending aorta filled with venous 
blood. 

Bevern, a laborer, sickened with cholera at one o'clock in 
the morning, and died in eleven hours. 

Dissection. — The facies cholerica was not strongly expressed : 
palms of the hands and soles of the feet a little wrinkled ; the 
extremities livid, and strongly muscular. Opening of the 
head. — The dura mater was reddened and injected with dark 
blood. The brain was soft, the vessels much injected; much 
blood flowed upon' cutting them ; both ventricles filled with 
serum, about half ounce in each ; plexus choroides very much 
injected ; glandulse pinealis empty ; cerebellum very soft, and 
much injected ; about an ounce of serum flowed from the spinal 
canal. Opening of the chest. — The vessels of the lungs were 
injected with dark blood ; the left ventricle of the heart was 
filled with black blood, and also the aorta. Opening of the 
abdomen. — The left lobe of the liver was enlarged, its substance 
pale; dark blood escaped upon cutting into it; gall-bladder 
not very full of bile ; it was thick and viscous ; spleen some- 
what injected ; intestines injected, reddish-livid ; some whitish 



REPORTS OF DISSECTIONS. 49 

fluid in them ; in the stomach flocculi floating in a yellowish 
fluid ; bladder much contracted and empty. 

John Uhl, aged twenty-two years, sickened on the 12th of 
October, and died the second night after the attack of cholera. 

Dissection. — Head bent backwards ; eyes violently drawn in- 
wards ; fingers and toes drawn inwards ; hands livid ; abdomen 
flat. Opening of the head. — Dura mater injected with dark 
blood : water flowed from the spinal canal. Opening of the 
chest and abdomen. — The lungs much loaded with blood, but 
little water in the pericardium ; heart large and flabby ; in the 
left ventricle much coagulated blood, also some in the right ; 
the intestines much inflated, and reddened on their outward 
surface ; bowels contracted ; bladder closely contracted, and 
not a drop of urine in it ; the gall-bladder full ; spleen much 
injected with blood, and easily torn ; the radial and crural ar- 
teries filled with venous blood. 

Henry Berg, forty-one years of age, was sent to the hospital 
on the 14th of October, and died the next day. 

Dissection. — The head was drawn back ; the arms contracted 
inwards; lower extremities very stiff*; the whole appearance 
haggard ; the eyes violently drawn upwards. Opening of the 
head. — Dura mater much injected; both ventricles filled with 
water ; the arteria basilaris much distended with blood. Open- 
ing of the thorax. — A little water in the pericardium ; no blood 
in the left ventricle, the right quite full. Opening of the ab- 
domen. — The liver very full of venous blood ; gall-bladder 
moderately filled with bile ; the outer coat of the intestine 
slightly reddened ; feculent matter in the small intestines ; 
spleen very soft ; bladder violently contracted, and contained 
a creamlike fluid; this was also seen in the pelves of the 
kidneys. 

John Katzal, aged thirty-four years, died after a few hours 
illness. 

Dissection. — Head bent backwards ; the arms in a flexed 
position, as also the fingers, and bluish ; legs flexed ; muscles 
very rigid ; fingers and toes wrinkled. Opening of the head. — 
There was a remarkable dryness of the membranes of the 
brain; the dura mater, and the brain filled with hypercar- 



50 EPIDEMIC CHOLERA. 

bonized blood ; in the ventricles a good deal of carbonized 
blood. Opening of the chest. — The lungs filled with hyper- 
carbonized blood ; some water in the pericardium ; heart large, 
soft, and lax ; much dark blood in both ventricles ; in the right 
there was a polypus, more than an inch long, broad and dense, 
in which was a hollow filled with serum. Opening of the ab- 
domen. — Bowels disturbed in their arrangement; an unusually 
fetid smell in the bowels ; outer coat considerably reddened ; 
the inner coat of the intestines slightly reddish ; the inner coat 
of the stomach and intestines reddish ; and in them was a por- 
tion of blackish matter, and in the latter the usual rice-water 
fluid ; an ulceration in the jejunum ; liver pale on the surface, 
little blood escaped upon cutting into it; gall-bladder filled 
with an inky fluid; spleen soft, and much injected with blood; 
kidneys contained a matter resembling pus ; bladder closely 
contracted, and empty. Opening of the spinal canal. — The 
brain and membranes reddened ; some serum under the arach- 
roid membrane ; the spinal medulla somewhat reddened, cauda 
equina, natural. All the arteries, even the smaller, were filled 
with hypercarbonized blood, the same in the venous system. 

Maria Harder, twenty-four years old, sickened on the 26th 
October, and died next day. Outward appearance. — Eyes 
drawn backwards, the head also ; great despair depicted in the 
face ; extremities flexed. Opening of the head. — There was a 
general turgescence seen upon opening the brain, and effusion 
of serum. Opening of the thorax. — The lungs were filled with 
venous blood ; heart large and flaccid ; both ventricles sur- 
charged with blood, and this obtained in the veins also. Open- 
ing of the abdomen. — The bowels somewhat deranged ; outer coat 
slightly reddish, and in these the usual contents ; the stomach 
contained a portion of blackish water, which resembled tincture 
of capsicum in smell ; there was several dark-red spots on the 
inner coat of the stomach ; liver pale on its surface, turgid 
within with hypercarbonized blood; gall-bladder filled with 
acrid bile of inky blackness; the spleen soft and injected with 
dark blood ; kidneys contained a portion of purulent matter ; 
bladder closely contracted ; the uterus, on its underside very 
red. Opening of the spinal canal. — The coats of the spinal 



DISSECTIONS AT MOSCOW. 51 

brain were much distended, and contained a large quantity of 
clear serum ; the cauda equina also much reddened, and also 
contained perhaps half a pound of fluid. 

SPECIAL REMARKS ON PROCEEDINGS AT HAMBURG. 

Among the singular facts attending the cholera at Hamburg, 
is, that although it existed there about two months, it did not 
occur in Harborg, a considerable town, immediately across the 
Elbe — up to the 6th of November, there had not been a case 
of cholera in that town. We have been led to believe, that the 
dissections at Hamburg are of the highest importance, and that 
they serve materially to illustrate the pathology of the disease. 
The reader may have remarked, that in most cases, the most 
strongly marked sign of the disease was turgescence of the 
vessels of the brain, and it is not a little remarkable that so 
great a degree of turgescence and effusion is seen to take place 
in so short a time. It appears also, that the bladder was found 
contracted and empty in almost all the cases. In a few in- 
stances there was a little muddy urine or pus — showing that 
this viscus is among those that suffer, although the kidneys are 
more at fault. We see occasionally turgescence of the lungs, 
of the liver, and in most cases, reddening of either the inner 
or outer coats of the stomach and bowels ; sometimes in both 
coats. Sometimes turgescence of the spleen, and in the kid- 
neys, &c. ; but in all this, there is but little uniformity ; these 
derangements appear rather as wayward associates, which 
nevertheless serve to show, the potency of the cause of the 
morbid phenomena attending the disease before us. 



DISSECTIONS OF CHOLERA SUBJECTS AT MOSCOW. 

We extract from the Edinburgh Medical and Surgical Jour- 
nal, for October, 1831. " The extract (says the editor of that 
journal) from the report of our countryman Dr. Keir, of 



52 EPIDEMIC CHOLERA. 

Moscow, supplies the first complete account we have seen, of 
the morbid appearances observed in the Russian epidemic, and 
we shall therefore transcribe it here verbatim, requesting the 
reader to compare Dr. Keir's description with that given of 
the appearances in the Indian cholera, by the report of the 
Madras Presidency, and extracted into this journal; the Rus- 
sian account runs thus : 

" The appearances in the dead body were not uniform, and 
varied according to the duration of the disease, and the cir- 
cumstances under which the patient died. As this was the 
case, I conceive the most satisfactory way, by which I can 
answer the inquiry on this head, will be to transmit the printed 
account of the dissections made at Moscow, and presented to 
the medical councils by its members, who occupied themselves 
the most with this part of the duty, while I add here the im- 
pressions made on my mind by the dissections at which I was 
present." 

"The extremities were, in general, more or less contracted, 
and the skin of the hands and feet corrugated, the features 
sunk and ghastly. On opening the skull, the bloodvessels 
of the brain and its membranes were more or less turgid with 
blood, particularly towards its base ; the arachnoid, and, some- 
times in several places, lost its transparency ; and adhered to 
the pia mater; a fluid was sometimes effused in the convolu- 
tions of the brain in some quantity; and more or less serum in 
the lateral ventricles. The bloodvessels of the vertebral 
column and spinal cord, were more or less loaded with blood, 
which was sometimes effused between its arachnoid membrane 
and dura mater. Partial softening of the substance of the 
spinal cord was sometimes met with; and marks of inflamma- 
tory congestion in the larger nerves. The lungs were gene- 
rally gorged with dark blood, and the cavities of the heart filled 
with the same, and frequently containing polypous concretions. 
In all the dissections I was present at, very dark-colored blood, 
which, when extended on a white surface, resembled the color 
of the darkest cherry, was found in the arch of the aorta, and 
in other arteries." 

" The state of the abdominal organs varied considerably ; 



DISSECTIONS AT MOSCOW. 53 

the stomach and different parts of the intestines, were fre- 
quently found to be partially, but considerably contracted ; the 
internal surface of the stomach seemed to belittle affected. A 
whitish or yellow fluid matter, resembling the evacuations, 
was frequently found in different parts of the alimentary canal, 
which, now and then, contained a great deal of air. In either 
case, both stomach and intestines bore marks of congestion, 
and of a sub-inflammatory state, varying from dark-colored 
spots of small extent to several inches, affecting the whole cir- 
cumference of the intestines. The color of these parts also 
varied a good deal, from dark-colored venous congestion to 
rose-colored inflammation. In one case the internal surface of 
the stomach was so strongly and so generally turgid, of a very 
dark color, that it might easily have been mistaken for gan- 
grene. On exposing the stomach between the eye and the 
light, it was evident that there was neither gangrene nor solu- 
tion of continuity, but that the dark color proceeded from a 
very general and great congestion of a very dark-colored 
blood, in the vessels of the organ. The subject of the case, I 
was told, had died of symptoms of a typhoid nature, after suf- 
fering from the usual symptoms of the epidemic. Excepting 
one case, which evidently was one of congestion, and not of 
inflammation, I saw nothing in the morbid appearances from 
which a conclusion could be drawn, that inflammation was a 
very general morbid change in the alimentary canal, or a com- 
mon cause of death ; however, by its presence in the second 
period of the disease, it might add to the general irritation, 
or, even as a consequence of preceding congestion, be itself 
occasionally a cause of death. Both the stomach and bowels 
were sometimes of a paler color than natural, both on the outer 
and inner surface ; but neither thickening nor condensation 
from inflammation, nor ulceration, destruction of substance, nor 
abscess, appeared in any of the dissections I was present at." 

" The liver was generally pretty full of dark-colored blood ; 
the gall-bladder frequently much distended with tenacious 
ropy bile, of a dark-yellow or green color; the gall-ducts 
sometimes contracted, at other times not ; the appearance of 
the pancreas, spleen, and kidneys was various, frequently differ- 



54 EPIDEMIC CHOLERA. 

ing but little from their natural state, in other cases rather 
surcharged with blood; the urinary bladder almost always col- 
lapsed and empty; uterus generally natural." 

The reader will here recognize a striking similarity between 
the appearances, as reported by Dr. Keir, at Moscow, and Dr. 
Fricke, at Hamburg. And it is particularly mentioned by 
Dr. Keir, that there was more uniformity in the evidence of 
congestion in the brain, than of other viscera. This we have 
pointed out particularly in our account of the dissections at 
Hamburg, and hence we derive the term cholera lethalis. 



PHYSIOLO-CHIRURGICAL OBSERVATIONS— BERLIN. 

A pamphlet bearing the above title, was forwarded to us in 
1832, by our talented and respected friend, Dr. J. F. Diffen- 
bauch, of Berlin, Prussia. These observations upon cholera 
patients embrace a species of vivisection, which were considered 
by us highly interesting at the time of their reception ; we 
still deem them worthy of record in a work on epidemic 
cholera. " This is a disease of vagrant character, and still in 
some degree the opprobrium medicorum. One is astonished," 
says our author, "to find that, upon cutting into the skin with 
a surgical intention, in a cold, bluish, pulseless cholera patient, 
to find no blood escapes, and the wound is cold as ice, and all 
the circumstances attendant resemble an incision upon a dead 
body. The sharpest knife moves along through the skin with 
difficulty, in the youngest person, full of blood ; [ought to be] 
the skin is so contracted and tough as to feel like that of an 
old woman. Indeed, an incision can be made with more facility 
in the dead body than in a pulseless cholera patient. An in- 
cision is readily made in the living skin, well-filled with blood, 
and made firm by its living economy, and hence it is that an 
operation can be more readily made on the living body than 
the dead. If we hold the skin in a fold, and cut through it 
with the knife, the incision will be made more or less easily 
in proportion as the fold is made more tense. The skin shows 
no disposition to retract when wounded with the knife. If 
we separate the edges, they remain stationary, and if replaced, 



PHYSIOLO-CHIRURGICAL OBSERVATIONS — BERLIN. 55 

they will remain so. If we separate the wound, with the cel- 
lular membrane, so as to expose the layers of membrane and 
muscle, the large vessels, and the venous cords, we may ob- 
serve the following phenomena : 

"We first observe, that the wound does not bleed at all, that 
the skin is bloodless, and does not present, upon an incision 
being made, the ordinary slight red, but mostly a cinnabar 
yellow. If the part wounded was in a livid state, the sides of 
the wound appear of a bluish-brown color ; if we wipe off the 
wound with a sponge, we observe that this coloring, from the 
division of the capillaries, brings forth a little treacle-like 
blood : but a portion of the fluid remains behind, and cannot 
be pressed out. In such cases, the surface of the wound is 
somewhat darker than where the skin is white. The fatty por- 
tion of the skin is of a glossy yellow color ; under the skin of 
young, healthy persons, as if it were weakened, is tough and 
less yellow, and in general it is very dry. 

" A most remarkable change is seen in the cellular membrane, 
which binds together the muscles ; it is generally rigid, dry, 
and clear, like a piece of isinglass ; the division of it presents 
the same transparency as that of the skin of cold-blooded 
animals, as the frog, turtle, &c. If we stretch it tightly, we 
can see through it. The aponeurotic membranes, the tendons 
and cartilages, appear white, but they have less of the usual 
silvery appearance ; they are much softer, and withered. 

" The muscles are not paler than common, but somewhat 
brownish ; their sensibility is less excited by mechanical irri- 
tation, in a remarkable degree, and any disturbance by art dis- 
covers but little delicate sensation. The larger nerves are 
also altered in their appearance ; they are much paler than in 
the usual surgical operations, and feel softer ; the irritability 
of the nerves of the skin is not altered, since the division of 
the skin of a cholera patient is attended with as violent pain 
as that of healthy persons ; at any rate, the otherwise torpid 
substance, when cut, gives rise to very violent pain ; and if we 
disturb a nerve, by means of an instrument, or pinch it with 
the forceps, we occasion severe pain, and if it goes to some 
particular muscle, the muscle is made to exhibit convulsive 



56 EPIDEMIC CHOLERA. 

movements, as is usual upon applying violence, as may some- 
times be seen in surgical operations. 

" The principal circumstances of the subjects under notice, are 
those connected with the vessels. The wound never bleeds, and, 
upon cutting, the cellular membrane looks as if it had been 
washed, or rather like an anatomical preparation of the eye ; 
but little lymph can be squeezed from the edges of the wound ; 
everything looks dry. If we wipe off the surface, it is long 
before it becomes moist again. It is but seldom one sees a 
portion of tar-like blood escaping from the wound of some ex- 
tent in the skin ; and the blood is so thick that it does not flow 
over the whole wound. By pressure, this dark blood may be 
made to come out of the vessels. The small vessels contain 
but little blood, and this viscid blood cannot be made to flow 
from the veins where we wish to draw blood. 

"There is a resemblance in the appearance of the veins to 
those of slaughtered animals — one may distinguish the dark, 
thickish contents through their coats. We do not find in them 
the usual equal distribution of the blood, but we observe an in- 
equality in parts closely adjacent, some being filled with very 
thick, and others with very thin blood. Where there is tur- 
gidness, it does not seem to be owing to increased force in the 
circulation ; the vessels seem to have lost the power of reac- 
tion, and appear to be dead. If we apply a finger to a turgid 
vessel, the blood readily yields to the pressure, both ways, in 
the vessel. 

"In the large veins, such as the vena axillaris, in muscular 
men, the shrinking up of the vessels is, to be sure, not quite 
so considerable, but I have several times seen the jugular vein 
empty, and with the size and appearance of a string of twine. 
By stroking along a vein with a finger, and moderate pressure, 
the vein may be entirely emptied, not only in the direction of 
the heart, but towards the periphery. If we let it remain still, 
it does not soon fill, but if we squeeze the limb, or press upon 
the muscles, the emptied vessel fills again, as well from the 
cardiac side as from the distal. 

" We find none but the larger veins turgid with tar-like blood, 
such as the axillary, jugulars, &c. ; those of middle size, as the 



PHYSIOLO-CHIRURGICAL OBSERVATIONS — BERLIN. 57 

brachialis, basilica, cephalic, and others, are generally empty, 
and there is associated with this, stagnation in the capillary 
vessels of the skin. In this, the friends of the belief of ob- 
struction see the very obstruction itself. It is particularly 
remarkable, that at times the jugulars are reduced in size, and 
very empty, while the arteries, to the touch, indicate their full 
activity. These veins do not fill upon pressure being applied 
near the clavicle, and, therefore, they cannot be the medium 
through which the blood returns from the head. At times, the 
middle-sized veins contain a considerable abundance of blackish 
blood, which does not move in them, but is formed into long 
coagula. This is sometimes seen in the subcutaneous veins ? 
and may be distinguished through the skin. The ordinary 
amount of blood circulated by such veins may be about one- 
fourth of the usual quantity in the healthy condition. If these 
veins be laid bare, their sides do not lie down flat — the vessel 
remains round, and resembles a cord. This smallness of the 
coats of the vessels is not owing to a living contraction, but de- 
pends upon the peculiar condition of the blood, which is 
formed into cord-like coagula. 

" At times, the vessels appear to be entirely empty, and like 
a thread, and again to be filled, but often quite empty. None 
but mechanical means can be made to push the blood in a vein 
that has been laid bare. Rubbing, warming, and working of 
the whole limb may propel the mass, but it is not by a living 
action, but the propulsion is entirely mechanical. If we find 
a large vein distended, and make attempts to expel the blood, 
by straight, long incisions, and find that the blood will not 
flow freely, it is not on account of the thickness of the blood, 
nor weakness in the vein, but particularly to the want of force 
in the arteries, since it is by the arterial circulation that the 
heart is made to press forward the venous circulation. Is it 
not possible that this fails in the disease before us ? If we, 
with Bichat, Broussais, and others, ascribe the circulatory func- 
tion to the capillary system, we shall find it, in the present case, 
entirely suspended. But we are reminded of the very interest- 
ing experiment of Magendie, who included the whole of the 
leg of a dog, except the principal artery and principal vein. 



58 EPIDEMIC CHOLERA. 

On the latter vessel he applied a particular ligature, and opened 
the vein near the ligature, on the distal side. The blood began 
to flow freely while the artery acted, but upon closing the 
artery by pressure, the blood immediately began to flow slowly 
from the wound in the vein, till the artery was emptied, when 
it ceased altogether. Perhaps," says our author, "if the ner- 
vous fluid had been suffered to pass the ligature, the circulation 
might have been revived. 

" The phenomena which we observed in the livid, cold, pulse- 
less cholera subject, differ in several respects from all we know 
respecting life or assimilation. The appearance of a large 
bared artery of a cholera patient differs in several respects 
from what is commonly seen. Generally, if the arteries are 
not specially diseased, we see them in other diseases "(after 
death) unaltered, as if they had performed their functions of 
life and sustentation. In ordinary circumstances, we see an 
artery that has been laid bare presenting the appearance of a 
white-reddish shining cord, possessed of elasticity. Here, on 
the contrary, we find it dull and lax, not for want of being 
filled, but because its coats have lost their living tension, or 
turgidness. It appears as if the artery had grown lean, and 
its coats loosened ; and the vessel does not seem merely to be 
disturbed in its economy, but impaired in its conformation. 
This altered condition of the arterial coats attaches, in some 
degree, to all the structures, particularly the membranous, the 
fibrous, and the cartilaginous. Their vasa vasorum are not 
visible, — not even through a lens. The whole vessel appears 
smaller in its calibre ; and, owing to the wasting of its coats, it 
is, in fact, smaller than natural." 

"I have often found the brachial artery not larger than a 
thread used by apothecaries. It is only in stout men that we 
may expect to see it larger. When we apply a ligature to a 
healthy artery, but little of the artery is to be seen, since the 
rotundity of the vessel, and the rising of its sides, will bury 
the thread from both sides ; here, on the contrary, the thread 
is mostly to be seen, since, owing to the softened state of the 
coats, they do not swell out and cover the thread. 

" In the cold cholera patient, there is at times a gentle pul- 



PHYSIOLO-CHIRURGICAL OBSERVATIONS — BERLIN. 59 

sation, and one has the sensation as if a little wave of blood 
has passed in the vessel. The circumstance is very strange 
that the thick blood which is present in the great vessels, can- 
not reach the extremities through the main vessels, or its col- 
lateral branches, in an unbroken wave, partly, because it is 
too thick, and partly because there is not sufficient force in the 
heart to propel it. 

"It is not easy to explain the phenomenon, that the coagu- 
lated blood is drawn into the heart, while the dying artery 
propels its contents by its last living function. From this 
thick blood in the heart's ventricles during life, are certainly 
formed polypous coagula, and the heart labors in vain to dis- 
charge its contents. Oftener, there are found coagula at the 
mouth of large vessels, and stops them up, or obstructs them 
so as merely to permit a thinner part of the blood to pass, and 
since I see these coagula in the large arteries, I may safely 
conclude that they exist in the living heart also. 

" Certainly, small waves of blood were seen sometimes upon 
opening a large artery. I took particular notice that if the 
artery of the arm was opened, while there was a slight pulsa- 
tion in it, there sometimes escaped a very thin blood ; but, in 
a majority of cases, where the vessel was opened, it ceased to 
pulsate. In one case of a blue, pulseless cholera patient, in 
the hospital of Dr. Romberg, I performed the operation of 
opening the axillary artery for a bloody inflammation, and im- 
mediately the blood flowed in a stream. The blood had a rose- 
color, was thin and warm, and at the same time the patient 
was as cold as ice, and had a livid appearance. It flowed 
like blood out of a vein, in an even curved stream. After 
I had drawn off four or five ounces, great debility ensued, 
while the emptying heart, by its action, was destroyed by its 
contractions ; the patient soon afterwards died. The blood 
flowed freely, and retained a red color. 

"Upon the more or less fluidity of the blood, and the power 
of the heart to propel it, depends the continuation of the action 
of the pulse. Sometimes a single propulsion of a wave of 
blood presents a slight or greater stretching of the artery, we 
feel sometimes, here now there, a single pulsation, — now we 
feel it in the radial, now in the brachial, and again in the 



60 EPIDEMIC CHOLERA. 

axillary ; and there is a slight irregular thrill, like resonance, 
from the feeble action of the heart. The arteries of the upper 
extremities are, in general, emptier than those below. The 
latter I have not opened in the living subject. But, when no 
pulsation could be perceived, I frequently saw in the dead sub- 
ject sometimes thin, sometimes thick blood. In general, the 
arteries contained blood in the dead subject, and yet during 
life they were empty ; the carotids pulsate most distinctly ; 
they do not, however, force the blood through the small vessels 
of the brain, otherwise the blood would return by the veins in 
greater quantity, and hence it is that the patient is left with 
the blood coagulated in the brain. 

" May not the blood, after it is driven as far as it can be, be 
made to pass backwards, as we have seen in some of the lower 
animals, which possess retrograde vessels. The peculiar pul- 
sation in the carotids gives the sensation of a pressure acting 
backwards upon the wave of blood. Where else is the blood 
to remain in the head, if the carotids continue to force it into 
the vessels, and the jugular veins do not bring it back again? 
and we have seen that these veins are generally empty. A 
similar state of things seems to obtain in other organs, as the 
lungs, where a circulation exists backwards and forwards in 
the larger vessels. The respiration seems to indicate this state 
of things, and the appearance of the lungs, after death, serves 
to support the opinion that such is the condition of cholera 
patients. If I inject into the veins of dogs gum water, it re- 
mains and produces an indescribable distress of breathing, and 
the hoarse sound resembling that of cholera patients ; and we 
find that the fluid has not passed into the capillary vessels, but 
remains in the larger vessels. The dissections of the lungs of 
these animals presents the same appearances as are seen in 
cholera subjects, the same stoppage and dark color in the sub- 
stance of the lungs. This is the true explanation of the diffi- 
cult respiration attended with hoarseness in cholera. [We 
think it probable that the hoarseness in cholera is owing to irri- 
tation of the reflected branches of the vagi.] 



OBSERVATIONS ON TRANSFUSION. 61 



OBSERVATIONS ON TRANSFUSION. 

"It occurred to my mind that the subject of transfusion was 
not only of high interest as regards the cholera, but that phy- 
siology, in general, might there by receive improvement, and in 
the hopelessness of the cases of cholera, we might try to sub- 
stitute for the tar-like blood, that of young persons in health, 
which, by being suited to the living economy, might stir up the 
heart, and thus enable this organ to free itself of the dying 
blood, and by the new blood give health and vigor to the ner- 
vous system. The fresh blood may give new impulse to the 
organism, and bring back things to their natural condition. 
It must be human blood which we dare transfuse, since the 
blood of different animals would endanger poisoning by the 
presence of prussic acid. Before attempted, we should take 
away a portion of blood, by which the circumstances associated 
with the operation will be lightened, without which the heart 
is made too full. [This cannot be done as a rule of practice.] 

" I made the injection by laying bare a vein under the skin in 
the arm, into which was introduced a small tube. The blood 
was drawn into a warm cup, and the blood drawn into a syringe 
was thrown slowly into the vein. The injection was made at 
intervals, and so as to throw in, in from five to seven minutes, 
at several times, an ounce at a time. The operation was at- 
tended by the following phenomena. In the first instant, the 
patient was only sensible of a swelling out of the veins, by 
which the blood was carried to the heart. Then came altera- 
tion of the pupils, sprightliness of the eyes, heavy respiration ; 
then return of pulsation, and warmth of the cheeks that were 
previously cold ; the hands and feet remained cold. Death 
succeeded the operation in one case in half an hour. No re- 
markable difference in the termination from other cases. The 
stethoscope indicated a thrilling sound at the heart. 

"The dissections, made with particular care by Dr. Phoebus, 
presented the following appearances : The heart and large ves- 
sels were filled with dark blood ; in one case the right jugular 
vein was found filled with air, but it did not extend to the sub- 



62 EPIDEMIC CHOLERA. 

clavian vein. In the vena cava superior, &c, was seen thick 
black reddish blood. In the left ventricle was seen sometimes 
a thinner blood, separated from the black blood. The brain, 
as in most other cases of cholera, was stuffed with black thick 
blood. 

" The most remarkable of all the appearances, which presents 
itself among others in the dissection of cholera patients, is the 
fact that the injected blood does not unite with the other blood. 
Does this depend upon a repulsive operation of the different 
kinds of blood upon each other ? or is this a struggle between 
the dying and living matter brought into contact ? or is it 
simply owing to indisposition to the union of thick and thin 
fluid? During the operation of injection, and before I was 
aware of what would be found upon dissection, I made these 
observations. A dram of thin cholera blood, which I drew 
from the arm, would not mix with a portion of red blood, which 
flowed from the arm in a stream, but remained separated. 
When they were mixed together, they made a marbled appear- 
ance." 

OBSERVATIONS ON THE PRESENCE OF AIR IN THE HEART AFTER 
DEATH. 

There being portions of air in the right side of the heart, 
and larger vessels, it became a question, whether it was formed 
in the vessels, or was admitted at the wound of the veins. I 
have been led to believe that the air is generated in the ves- 
sels, since I have several times observed, when I had laid bare 
a vein, air could be seen in the vessel. Sometimes it remained 
stationary, sometimes, upon stirring the limb, the air passed 
towards the heart. This was the case in the subject upon 
whom Dr. Bohr practised transfusion ; when that operation 
was performed, he is certain that his experience upon brutes is 
such as to enable him to inject blood into the vein without 
passing in a particle of air. It is only a large quantity of air 
in the vessels that kills instantly, and not because it is a poison 
as some have supposed ; but it kills by mechanical obstruction 
of the capillaries of the lungs. It remains in the lungs like 



PRESSURE OF AIR IN THE HEART AFTER DEATH. 63 

mucilage, quicksilver, or other thick fluids, which remain and 
obstruct the air vessels. Death occurs here not from derange- 
ment of the heart, but of the lungs." Dr. Diffenbauch, not- 
withstanding the unfavorable termination of the cases in which 
transfusion had been employed, seems to think, that the prac- 
tice is deserving of further attention in desperate cases : if 
this remedy fails, so do others. 

We are told that, in a patient, who was dying, and suffering 
great anxiety and laborious respiration, our author, with the 
approbation of Dr. Casper, opened the brachial artery in its 
upper third, and passed in a flexible tube to the heart, and no 
blood flowed through the tube, even when the tube had reached 
the heart ; the action of the heart became stronger and more 
frequent, and the tube was immediately withdrawn. 

It is said in support of the fact, that a partial interruption 
of the pulsation of the arteries and a total suspension of the 
circulation, the following case is noticed. Our author opened 
the artery of the left arm of a woman, in the hospital of Dr. 
Casper, in the lower third, and it was with difficulty that a 
small quantity of black blood could be obtained. The artery 
was now tied with a ligature, and the edges of the wound ad- 
justed. Strange to tell, " the arm, though long covered with a 
cold moisture, became before death covered with a warm mois- 
ture ; the skin was warm, and the living aspect returned, with 
a pretty good pulse in the radial and ulnar arteries. This cir- 
cumstance is supposed to be important, because it is an encou- 
raging fact that, in cholera patients, cold and half dead, we 
find there is still a possibility of a renewal of the circulation." 

"The process of adhesive inflammation, or union by the 
first intention, was not interrupted by the reduced state of 
health of the skin, but rather facilitated. The orifice from 
bleeding, or other small wounds of the skin, healed quickly; in 
young persons, these wounds take on inflammation sometimes, 
and run into suppuration, as was occasionally observed in hos- 
pital cases." Our author thinks, upon the whole, that in cholera 
patients, there is a pretty vigorous condition of the plastic 
principle of life ; a remark which would apply to paralytic 
limbs ; in both cases, wounds heal quickly, or run rapidly into 



64 EPIDEMIC CHOLERA. 

inflammation, and, in the latter case, there is a speedy termi- 
nation ; but, in cases of cholera, opportunity was not had to 
observe the former. 

We are told, one might suppose, that large wounds in cholera 
patients, being left open to heal by suppurative inflammation, 
would remain very dry, on account of the general dryness of 
the body, as we see in wounds in cases of typhus fever, in 
which the process of suppuration is entirely interrupted. It 
has been remarked that wounds in cholera patients are very 
dry; charpie remains dry, and the deposition of lymph takes 
place later than common. The lips of the wound remain very 
little hardened and pale; but, after a time, there is very little 
secretion into the wound of a thin purulent matter. The pus 
is sometimes not thicker than milk, has a whitish yellow color, 
and looks much like oatmeal gruel, but a little whiter ; has a 
faint smell, and when dropped into water it falls to the bottom, 
but forms into threads, and some mucilage. The granulations 
of wounds are of very fine grain, and look pale. A similar 
appearance attended a wound made in a case of strangulated 
omental hernia. Six or eight days afterwards, this patient was 
seized with cholera, and died of the disease. In this case the 
healing process advanced rapidly, and healed with extraordi- 
nary quickness. 

The foregoing experiments bring to our recollection an 
opinion which we have long entertained, that, in most epi- 
demics, cases of sudden death have been preceded for several 
days, sometimes much longer, with disorder of the system, before 
the fatal outbreak ; and very often there are premonitory signs, 
which, if attended to, would prevent the disease from becoming 
dangerous, or, perhaps, from forming at all, and this, we think, 
is especially common in epidemic cholera. 

We will not undertake to judge for our readers, how far these 
vivisections upon the human body are warrantable; we leave 
each one to make his own conclusions. We may remark, how- 
ever, without making ourselves a party in the matter before us, 
that, as these cases were necessarily fatal, and the experiments 
did but in a slight degree increase their suffering, and the sub- 
ject of cholera w T as involved in much obscurity, and a strong 



EXAMINATION OF DIFFENBAUCH'S EXPERIMENTS. 65 

necessity existing for light on the subject, there is little, if any 
room, for censure. Knowing the author personally, as we do, 
we would be little disposed to think that he would engage in 
novelties without a strong expectation of doing good. 



EXAMINATION OF DIFFENBAUCH'S EXPERIMENTS. 

DifFenbauch tells us, that he found " the large nerves paler 
than usual." This circumstance seems worthy of notice, since 
there is strong reasons for believing, that the first great link 
in the catenation of destructive phenomena, is nervous de- 
rangement of the splanchnic system, by which the whole living 
economy is thrown into ruin. We w T ish the reader to carry 
this observation to our description of cholera. Our author has 
said " it is particularly remarkable that, at times, the external 
jugulars are reduced in size, and very empty, while the arteries, 
to the touch, indicate full activity. These veins do not fill 
upon pressure being applied near the clavicle, and therefore, 
they cannot be the medium through which the blood returns 
from the head." We have not noticed the exact condition of 
the external veins, but nothing, perhaps, is more common than 
to see the carotids having a good share of activity, while there 
was no longer any pulsation in the radial arteries ; and when 
we look at the injected condition of the brain, and associated 
structures, we observe a phenomenon which we cannot explain. 
Diffenbauch would explain it on the ground of retrograde ac- 
tion in the arteries, by which the blood is thrown back ; but 
it is not easy to see where it can be thrown backwards. The 
large arteries, by their abundant supply of vasa vasorum, seem 
to have a sort of erectile condition ; and may appear more 
tense than they really are, and so, on the contrary, arteries 
when over-distended with blood manifest less activity of the 
circulation, than really exist within the vessel, from which we 
deduce an important indication for bleeding, in cases of disease 
of an inflammatory character. Of this state of things, we may 
5 



C6 EPIDEMIC CHOLERA. 

judge by the circumstances associated with each case. We 
believe, then, that an artery may present more force, or less 
force, than the amount of blood passing indicates. It maybe, 
too, that much of the accumulation of blood in the encephalon 
may occur in the advanced stage of the disease. We imagine 
it a possible case for the arterial blood to wave back and for- 
ward where there is great debility. 

We find in the observations before us, the following remarks : 
" It appears as if the artery (when laid bare) had grown 
lean, and its coats loosened ; and the vessel does not seem to 
be merely disturbed in its economy, but impaired in its con- 
formation. This altered condition of the arterial coats at- 
taches, in some degree, to all the structures, particularly in the 
membranous, fibrous, and cartilaginous ; their vasa vasorum 
are not visible, not even with the lens. This falling off in the 
size and firmness of the structures, corroborates what we have 
said respecting an erectile property in the arteries, in particu- 
lar ; and, the more or less plumpness of the veins and mem- 
branes, is owing to the relative condition between the structures 
in the abstract, and the vital fluids. We have here the appal- 
ling fact, that the entire economy of the system is thrown into 
disarray in cholera, as it advances rapidly from bad to worse ; 
for, when once the vital influences between the assimilating 
nerves, with its brainular connection, is withheld from the re- 
ceiving capillary organization, the living power is, so to speak, 
dethroned, and death soon immolates the victim ; nor can 
human skill avail after a certain period, for the first seat of 
life is destroyed. 

"In general, the arteries in the dead subject contain blood, 
and yet, during life they were empty." This has been shown 
by Diffenbauch's experiments. We have remarked in reading 
accounts of dissections of cholera patients, that little or no 
notice is taken of the state of the membrana conjunctiva, but 
in the cholera of the present year (1854), this has been almost 
a uniform symptom ; nor must we forget to notice the almost 
constant appearance of serum in the brain, as well in the spinal 
as the cerebellum, or rather at the base of the brain of the 
head. We are aware that but a short time will suffice to pro- 



DIFFENBAUCH ON TRANSFUSION. 67 

duce serous collections in inflamed parts ; but there is no 
symptoms to support the supposition, that there is any inflam- 
mation as a part proper of cholera. We see cholera often 
terminating in a few hours ; and, upon dissection, serum exists 
in considerable quantity at the base of the brain, or in the 
ventricles. We believe with Diffenbauch, that the blood ac- 
cumulates in the head for want of propelling power in the 
vessels, especially the veins ; and here we see just ground upon 
which to place the ancient views of a vis a tergo, — and in this 
vis a tergo is necessarily associated not only the venous system, 
but also the motor power of the nervous system ; — a power of 
propulsion, which fails as cholera advances. 



DIFFENBAUCH ON TRANSFUSION. 

Speaking of transfusion, our author says : " The fresh blood 
may give new impulse to the organism, and bring back things 
to their natural condition. It must be human blood which we 
dare transfuse, since the blood of different animals would en- 
danger poisoning by the presence of prussic acid." Blood was 
drawn into a warm cup, and injected at intervals ; an ounce 
was thrown at a time, till several ounces were thrown in, in 
from five to seven minutes. The patient was first sensible of 
a fulness of the vein by which the blood was carried to the 
heart. " Then came alternation of the pupils, sprightliness of 
the eyes, heavy respiration ; and afterwards return of pulsa- 
tion, and warmth of the cheeks that were previously cold ; the 
hands and feet remained cold. Death succeeded the operation 
in one case in half an hour." 

It is said we must use human blood, because the blood of 
other animals contains prussic acid. Besides this objection, 
we must not forget that the organization of our blood is pecu- 
liar, and that each animal has, no doubt, its blood-cells pecu- 
liar, which is organization ; and organization is as essential to 
life in the blood, as that of the solids. We lose sight of the 
physiology of the blood, when we suppose it to hold its vital 



68 EPIDEMIC CHOLERA. 

power while exposed to the atmosphere, already tortured to 
death by being subjected to the violence of falling through 
a cool air, and being subjected to the violence of falling, and 
then forced in and out of a syringe. 

We will here state a case of transfusion, which we practised 
some years ago, at the Maryland Hospital, which we do from 
memory. A man had cut his throat so as to divide the trachea, 
and although the principal arteries were not wounded, he had 
lost so much blood before his admission, that he was now nearly 
pulseless, and of course, extremely prostrate. 

While we were preparing for coaptating the parts, he was 
nearly suffocated by the lower fragment of the trachea sinking 
in under the integument. A sailor volunteered to furnisk 
blood, and we proceeded to inject a portion into his arm. It 
was, however, of no avail, he died in a few hours. 

We would here call the reader's attention to the report of 
Dr. Diffenbauch respecting the indisposition of the blood of a 
healthy person and that of a ^cholera patient to mix, whether 
attempted by injection into the living veins, or mixed in a cup ; 
in the latter case, the mass assumed a marbled appearance. 
We have something to say respecting some experiments which 
we made in 1832, upon cholera patients, by saline injections; 
but we defer this till we come to speak of our treatment of 
epidemic cholera in Baltimore in that year. 

Diffenbauch thinks, "upon the whole, there is in cholera pa- 
tients a pretty vigorous condition of the plastic principle." 
We must here most decidedly differ with this opinion, if taken in 
a general sense. That there may remain a certain amount of 
the plastic principle in the skin, as stated by our author, we 
will not question ; but, so far from there being anything like a 
normal share of this principle in cholera patients, it is this vis 
plastica that is especially assailed in cholera ; the whole ab- 
normal phenomena being primarily and principally seated in 
the organs of the assimilating economy, and, so far as the 
greater organs of sustentation are concerned, the grand sys- 
tem of splanchnic nerves is primarily and especially involved, 
the ganglionic centres lose their equipoise, and thus it is that 
assimilation fails. 



DIFFERENCE OF EPIDEMIC CHOLERA AND CHOLERA MORBUS. 69 

"We have elsewhere contended that inflammation is not neces- 
sarily present in the healing of wounds. The experiments of 
Dr. Diffenbauch go to support our opinion. That is, inflam- 
mation, though almost uniformly present in wounds, is not 
positively necessary; on the contrary, the less inflammation 
present, as a general thing, the sooner will the wound heal by 
the first intention. In this, we think, we see a confirmation of 
our own opinion, that inflammation need not come to the aid of 
adhesion of living parts, and that in cholera patients the skin 
is weakened in its vital forces to a degree that lessens the ten- 
dency to inflammation, and may, thereby, possibly increase the 
adhesive condition, in which we have a confirmation of the 
accuracy of Diffenbauch's observation, that wounds of the skin 
in cholera patients readily heal. 



DIFFERENCE BETWEEN EPIDEMIC CHOLERA AND CHOLERA 
MORBUS. 

In the brief historical account which we mean to offer, we 
design introducing occasional remarks on other characteristics 
appertaining to the disease. We think it highly important 
that the general public, as well as the medical, should have 
correct views of this disease, and as it has fallen in our way to 
see a good deal of epidemic cholera, we hope to be usefully 
employed in presenting such knowledge as we have been en- 
abled to collect on this momentous subject. After a good share 
of observation and experience, we believe we are justifiable in 
declaring, as our opinion, that, when considered and adjudged 
on the broad ground that the epidemic cholera covers, we can 
truly say that, by the judicious employment of precautionary 
measures, both public and private, we may greatly lessen the 
mortality, quiet the apprehensions of the citizens subjected 
to the disease, and show that, although liable to become a de- 
structive disease here and there in a community, it is, never- 
theless, a mild disorder in a vast majority of cases, and easily 
manageable at its inception. 



70 EPIDEMIC CHOLERA. 

There is the most satisfactory evidence that the cholera, 
which made its inroads upon the city of Baltimore principally 
in the year 1832, and has, so to speak, become acclimated in 
this country, is no new disease. The most remarkable epi- 
demic of this sort which has prevailed, was early in the 14th 
century, a time when medical learning was at a very low ebb. 
There is accounts of a most frightful aspect relating to this 
disease in different parts of Europe; some of the towns in the 
north of Europe, if we may believe the chronicles of the times, 
must have been nearly depopulated. We have the most fright- 
ful accounts of its existence at Lubec, in the Danish dominions ; 
and notwithstanding that that city is not materially altered in 
anything relating to its localities, its buildings, or the charac- 
ter of its inhabitants, the cholera of 1831, which raged at Ham- 
burg, thirty English miles distant, did not reach Lubec. But 
of this appalling epidemic of the 14th century, we have no 
satisfactory medical account. It was known by the name of 
Black Death, a term no doubt derived from the remarkable 
prevalence of a lividness of cholera patients in malignant 
cases. 

While we express as our opinion that the epidemic, which 
made its appearance in Baltimore in 1832, was not a new dis- 
ease in the great domain of the world, we must admit that, to 
us of the present time, it is as new as though it had never 
existed ; and hence it is, that the several countries of Europe, 
like our own, were taken by surprise in encountering the dis- 
ease, the more so from its possessing such a vast dominion, 
and in this respect it is new. The disease has assumed rather 
the endemic than the epidemic character, there being no rea- 
sonable ground for supposing that the influence giving rise to 
the disease has any direct bearing from city to city ; while, on 
the other hand, influenza seems to have such a general bearing. 
But the term epidemic cholera has become familiarized, an- 
swers our purpose, and, therefore, needs no alteration. 



ACCOUNT OF CHOLERA BY MADRAS MEDICAL BOARD. 71 



ACCOUNT OF CHOLERA BY MADRAS MEDICAL BOARD. 

We are indebted to the Madras Medical Board for the fol- 
lowing particulars: "A disease having, in October last, pre- 
vailed at Arcot, similar to an epidemic that raged among the 
natives about Paliconda, in the Abrose Valley, in 1769-'70, 
an army of observation, January, 1783, and in the Bengal de- 
tachment at Gangam in 1781, and in several other places, at 
different times, as well under the appearance of dysentery as 
cholera morbus, or mordixim, but attended with spasms of the 
precordia, and sudden prostration of strength, as characteristic 
marks." 

We are next reminded of the account of Bontius, a Dutch 
physician, who wrote of the disease at Batavia in 1629. He 
says the cholera morbus "is extremely frequent;" the patients 
often die of it "so quickly as twenty-four hours at most;" 
"this disease is attended with a weak pulse, difficult respira- 
tion, and coldness of the extreme parts, to which are joined 
great internal heat and insatiable thirst, perpetual watching 
and restlessness, and incessant tossing of the body. If, to- 
gether with these symptoms, a cold fetid sweat breaks forth, it 
is a certain sign that death is at hand." 

Dr. Paisley notices cholera in 1774 at Madras. He says, 
"it is often epidemic among the blacks, whom it destroys 
quickly." When the disease is epidemic, "it brings sudden 
prostration of strength and spasms over the whole body." Dr. 
Sonnerat notices the disease, as it appeared 1774 to 1781: 
"There is also another disorder which reigns, and in twenty- 
four hours, or sometimes less, carries off those who are at- 
tacked." Debauchees, and those who have indigestions, are 
attacked with a looseness, or rather with an involuntary flux 
of excrementary matter, become liquid. This "flux," some 
years ago, destroyed about sixty thousand people from Cheri- 
gam to Pondicherry. The symptoms of this disorder were a 
watery flux, accompanied with vomiting and extreme faintness, 
a burning thirst, great oppression of the breast, and suppression 
of urine. Two years afterwards there was another epidemic, 



72 EPIDEMIC CHOLERA. 

in which "those who were attacked with it had thirty evacua- 
tions in five or six hours, which reduced them so weak that 
they could neither move nor speak. They were often without 
pulse, and the hands and ears were cold ; the face lengthened : 
sinking of the sockets of the eyes was a sign of death." 

Cholera was observed at the Mauritius, 1775 and 1819. Dr. 
Burne says, " the mortality was particularly among the blacks." 
At Gangam the cholera was extensively seen as an epidemic. 
"It seized them with almost inconceivable fury. Men, pre- 
viously healthy, dropped down by dozens ; and those less se- 
verely affected, were generally dead or past recovery in an 
hour. The spasms of the extremities and trunk dreadful ; dis- 
tressing vomiting was present in all. Besides those who died, 
upwards of five hundred were admitted into the hospitals 
daily." 

This disease has been noticed by Curtis in 1782. From 
this up to 1790, the disease is said to have prevailed very fre- 
quently in different parts of the East Indies. It would be use- 
less to repeat the symptoms ; they were generally such as we 
have already noticed. 

It is stated in the Bengal Report that, in April, 1788, cholera 
destroyed above twenty thousand people who had assembled at 
a festival. The Madras Board of Health observe, that those 
authorities would seem, accordingly, to establish the fact of its 
existence during the period extending from 1769-'70 to 1787, 
where we find the first records of this office, as given in the 
extracts, and which we now come to consider. 

Dr. Duffin treats of cholera in 1787. "The cholera rages 
at Arcot with great violence ; many of the men are carried off 
in twelve hours' illness." The symptoms are such as we have 
already noticed, and need not be repeated here. This epidemic, 
under the notice of Dr. Duffin, seems to have partaken a good 
deal of the spasmodic character, and seems to have been no- 
ticed by Mr. Thompson also, who says, among other things, 
that the bladder was contracted to the size of a walnut. 

Cholera has also been in the Northern Circars. "The 
disorder was characterized by precisely the same symptoms 
which marked the late epidemic. It began with violent spasms 



ACCOUNT OF CHOLERA BY MADRAS MEDICAL BOARD. 73 

in the stomach and bowels, which were followed by purging 
and vomiting, and all the signs of extreme debility." 

We do not deem it necessary to pursue the historical account 
of the Madras Medical Board further than to copy a few ob- 
servations which we consider important. It is said, in the 
paper before us, "Having, in the preceding desultory remarks, 
attempted to trace the existence of cholera in India, from a 
very remote period down to that of its appearance in 1817, 
sometimes coming as a pestilence upon the land, at others 
visiting only particular tracts ; and having also attempted to 
show grounds for inferring that we are not acquainted with all 
the instances of its epidemic visitations, nor by any means 
aware of the extent of its occasional or sporadic appearance; it 
only remains to refer the reader to the valuable reports of the 
Bengal and Bombay Boards, for information respecting its 
late march through the respective territories of those Presi- 
dencies ; to Mr. Orton's separate work for many interesting 
particulars of its appearance here ; and to the narrative at 
the first page of the report for an account of its progress 
through the Madras Territories. This narrative has been com- 
piled from official reports; and, as it is intended to exhibit the 
history of the disease, as a sort of memoir to the map which is 
prefixed, it has been, as much as possible, divested of all medi- 
cal reasoning. 

"Cholera has generally been classed by nosologists under 
the head of fluxes; but Cullen, though retaining the name, 
which he understands to signify a flux of bile, and defining the 
disease to be so, or of a bilious humor, places it in his class 
neuroses, and constitutes it a genus of the order spasmi. 
Dr. Good, in his late valuable work, the Study of Medicine, 
retains the generic term cholera, which he justifies on the 
ground that the bile is morbidly affected, in its secretion, either 
in quality or quantity, and he places it in the class cceliaca, or 
diseases of the digestive function, and in the order anterica, or 
diseases affecting the alimentary canal. 

" We are told that the term spasmodic, applied to Indian 
cholera, has met with very serious opposition; for, if restricted 
to the affection of the muscles of voluntary motion, it applies 



74 EPIDEMIC CHOLERA. 

to a symptom of minor importance, which, in a great proportion 
of cases, does not occur at all, of which the existence in other 
parts of the system cannot, by any means, be held as incontesta- 
bly proved. The term cholera ejndemica, is that which has been 
chiefly used of late, especially in official papers, and hitherto 
it has been sufficiently understood ; but it is obviously adopted 
for temporary application only. I may, therefore, be allowed 
to substitute a term, by which it will be attempted to show, im- 
ports an unfailing diagnosis of this species of cholera, namely, 
the sinking, or arrest of the circulation, and, accordingly, we 
would call it cholera asphyxia, using the word asphyxia only 
in its restricted sense, that is, the stoppage, or suppression of 
the pulse." 

"This proposed specific term, asphyxia, will, it is presumed, 
designate the disease unerringly; for, as far as our knowledge 
of it, either from history or observation, hitherto extends, there 
appears to be in all cases an evident tendency to sinking of the 
circulation ; and an apparent arrest of it in the vessels of the 
extremities, if we may judge from the absence of pulse, and 
from the effects of venesection, in every instance where the 
complaint is not early cut short by art ; and, especially, an 
arrest of it in every vessel accessible to our senses, in all fatal 
cases, at a period before death, comparatively more remote 
than is known in any other disease." 



REMAKES ON THE REPORT OF THE MADRAS BOARD OF 
HEALTH. 

The reader will perceive, that the foregoing observations and 
remarks, are taken from the Report of the Madras Board of 
Health. It is assumed in the papers from which we have 
selected our historical narrative, that asphyxia is a name 
better suited to epidemic cholera than any other that has been 
employed. From this opinion we differ, because the symptom 
upon which the epithet is founded, only applies to desperate 
cases, and those far advanced, a condition from which almost 
none recover, while there exist hundreds of milder cases, in 
the same epidemic. We suppose it will be admitted, on all 



REMARKS ON REPORT OF MADRAS MEDICAL BOARD. 75 

hands, that epidemic cholera arises from atmospherical con- 
tamination, and in all its bearings is the offspring of a peculiar 
malaria. This is an important feature in the subject before 
us; and affords a satisfactory ground of distinction between 
ordinary cholera morbus, and the widespread cholera. Cholera 
morbus has no specific cause, but is produced by fortuitous 
causes, and is only seen sporadically ; for, if several persons 
are exposed to over-eating, over-exertion, over-heated, &c, one 
may have an attack of cholera morbus ; another a gout ; an- 
other sick-headache ; but there is a specific cause of the cholera 
epidemic, which will, like small-pox, produce one disease only, 
and that mostly epidemically ; so much so, that this is the 
strongest trait in its character : and hence we derive a name 
the most satisfactory for the disease which appeared first in 
this country in 1832, and has existed in some part of our 
country ever since. It is deservedly called epidemic cholera. 

As to any nosological arrangement of this disease, every 
attempt at such an achievement must ever be abortive ; nor 
will the lights we possess upon its pathology do more than lead 
us by the hand through the mazes of cholera. We have, in a 
preceding part of this work, endeavored to show that this dis- 
ease, like all epidemics, is modified, from year to year, accord- 
ing as seasons produce modifications in the malaria, which 
though everywhere and always one product, has nevertheless 
aspects or conditions, which call for different modes of treat- 
ment. We may remark, in point, that there was a striking 
similarity between the cholera as seen at Hamburg, in 1831, 
and in that of Baltimore of the year 1832 ; while, between 
those epidemics and those which we have seen in the present 
year (1854), there was a striking difference. In the Madras 
reports, we read: " There is a very fatal form of disease also 
known in Travancore, called ' the red-eye sickness' by the na- 
tives, which is evidently a modification of cholera." This has 
pretty strongly characterized the disease of 1854; a few cases 
of which we have seen in Columbia, and in York, Pennsylvania. 
We have seen decided differences also in Baltimore ; though 
the disease has only existed there at any time sporadically 
since 1832. One year most of the cases exhibited more of the 



76 EPIDEMIC CHOLERA. 

spasmodic cholera, with less coldness of the tongue ; but we 
shall have to speak more fully when we come to our description 
of epidemic cholera, and of its treatment in 1832. 

It appears by the foregoing history of the disease, and some 
additional reports by the Madras Board, that cholera did not 
commence as has very generally been supposed, in the year 
1817, in India. From that date it seems to have taken a very 
strongly marked epidemic character. 



BEPORT,OF PHILADELPHIA COMMISSION, 1832. 

We shall avail ourselves of the labors of the Philadelphia 
Health Commission, for a brief sketch of the disease, from 
1817 down to its appearance in Paris. It is said, that " the 
epidemic cholera commenced its ravages in various parts of the 
Delta, formed by the mouth of the river Ganges, in India, 
during the summer of 1817. Presenting many of the features 
of the ordinary cholera morbus, it had some symptoms super- 
added, which distinguished it from that disease. The chief of 
these latter are, suddenness of the attack, and the rapidity of 
its course ; the extreme exhaustion of the animal powers ; the 
distressing cramps or spasms of the muscles of the limbs and 
body, which commonly attended it ; and, more especially, its 
strongly marked epidemic character. 

"Continuing its ravages from the period mentioned, by the 
end of 1818 the disease had pervaded nearly all of Hindostan, 
from the Himalayah Mountains on the north, to Cape Como- 
ran on the south ; and from Bombay and Surat, on the west, 
of Sylhet, on the east. In 1819, it broke out in the kingdom 
of Arracan on the east ; Peran and Java on the southeast ; 
and in the Isles of France and Bourbon on the southwest. The 
effects of the epidemic were also experienced still further to the 
southeast, over the whole of the Indo-Chinese peninsula. In 
1820 it prevailed in Siam, Malacca, and the Philippine Islands, 
the southern provinces of China, and at Guzzerat, in India. In 
1821, it occurred at Muscat, on the southern extremity of the 
Arabian peninsula, and again in the Island of Java. During this 



REPORT OF PHILADELPHIA COMMISSION, 1832. 77 

season Bushire, Sebiraz, and other parts of Persia ; Bossara 
and Bagdad, in Arabia ; the Island of Bahrian in the Persian 
Gulf; and the Island of Borneo, suffered very severely from 
the epidemic. During the succeeding winter, the disease 
became dormant, both in Persia and Syria ; but in the spring 
of 1822, it made its appearance again, among other places 
in Ispahan, Tehara, Tabritz, Moussul, and Diarbecker. By 
the end of the year, indeed, almost every place of note in 
Persia had been ravaged by the pestilence. In the spring of 
the year ensuing, 1823, it broke out at Latokia, Antioch, Tor- 
tosi, Tripoli, and in other towns along the eastern shores of 
the Mediterranean ; and in the Spice Islands, as well as still 
further south in the Island of Timor, near New Holland. Pre- 
viously to the autumn of this year, the disease had prevailed 
throughout the provinces of Asiatic Turkey ; from Bassora and 
Bagdad, to Ezeroum and Antioch : Egypt, however, escaped 
until a much later period. In August of this year, the disease 
prevailed in the province of Shervan, and in Backu, as well as 
in other places on the western side of the Caspian Sea ; and it 
finally made its appearance in the city of Astracan, near the 
mouth of the Volga. Subsequent to the year 1823, the disease 
continued its ravages throughout China, and in various parts 
of India ; and towards the close of 1826, it almost depopulated 
several cities in Mongolia, occurring as far north as the borders 
of Siberia. In 1820, it appeared at Tiberius, in Judea. In 
Persia the epidemic reappeared several times ; the city of Te- 
heran being ravaged by it in 1829. In 1828, the disease was 
once more in the Russian dominions, appearing unexpectedly 
at Orenburg, a town situated on the Ural River, four hundred 
and eighty miles northeast of Astracan. On the setting in, 
soon after, of cold weather, it, however, completely and 
promptly ceased. But in the summer of 1829, it recommenced 
its ravages with greater severity, and occurred at many places, 
also, in the neighborhood. About the middle of June, 1830, 
the cholera made its appearance in Tiflis, a city in Georgia ; 
and in the meantime re-occurred at Backu. By the 20th of 
July, Astracan was for the second time a sufferer from the 
epidemic. This disease occurred successively in various towns 



78 EPIDEMIC CHOLERA. 

and villages situated along the shores of the Volga; and from 
the south of the Caspian Sea, Iver, and Vologia ; in a short 
period the disease made its appearance at Archangel, on the 
north, and in the greater part of Poland on the south ; ravag- 
ing, in fact, the principal places, from the borders of Prussia to 
Odessa, and from Odessa to the White Sea. 

" The disease appeared at Moscow the middle of September, 
1830. In April, 1831, Warsaw was attacked; Riga, in May, 
Archangel, in June ; in the latter month the disease appeared 
likewise at St. Petersburg, and in July at Cronstadt. In 
Dantzic, in Prussia, the epidemic broke out in May, 1831, and 
at the same time in Brody and Lemburg, in Austria. In 
Berlin the disease commenced in August ; in Vienna in Sep- 
tember ; it likewise occurred in various parts of Hungary ; and 
before the close of the year, it had desolated nearly fourteen 
towns and villages. In October it suddenly appeared in Ham- 
burg, and in different parts of the kingdom of Hanover. In 
the month of August, it made its appearance in the eastern 
part of England ; Sunderland, a sea port in the county of Dur- 
ham, situated at the mouth of the river Wier. The disease 
did not, however, attract much notice till near the end of Oc- 
tober. In December it prevailed at New Castle, on the Tyne, 
to the north of Sunderland, and at Gates End to the south. 
It likewise appeared subsequently, in various places to the 
west, and in different parts of Scotland. London became sub- 
ject to the epidemic in 1832, and at Dublin, and different parts 
of Ireland ; while in May, 1832, it prevailed to an alarming 
extent at Paris, and its neighborhood. 

"In the month of June, it made its appearance at Montreal 
and Quebec, and was attended with great mortality. The 
disease also appeared at New York in the same month, and at 
Philadelphia in July ; — presenting there, however, at that time 
but a few sporadic malignant cases, but became epidemic." 

It was announced in the newspapers of the morning (July 
25, 1832), that the Medical Commission sent by the Board 
of Health of New London to investigate the disease, and 
they were made acquainted with a disease precisely similar, 
in the winter of 1831-2, at which time it prevailed at New 



CHARACTER OF EPIDEMIC CHOLERA. 79 

London, and, it is said in the London Medico-Chirurgical 
Journal, that Dr. Dobson described the same disease, as it ap- 
peared at Leeds, in England, in the year 1825. 



CHARACTER OF EPIDEMIC CHOLERA. 

The first trait which we shall notice of this disease, is that of 
its being sometimes epidemic, sometimes seemingly endemic, 
and sometimes seen sporadically ; but we believe it is al- 
ways non-migratory. An epidemic disease, says Webster, is 
one which seizes a great number of people at the same time, 
or in the same season. And he refers' to the influenza of 
October and November, 1789 ; that of March and April, 1790, 
that of the winter of 1824-5, and that of 1825-6, which were 
very severe epidemics. Let us digress here, one moment, to ask 
the question, What gave rise to those epidemics ? They could 
only arise from some specific cause, and that inherent in the 
atmosphere, just as we see in cholera, or any other epidemic, 
except small-pox, which, though sometimes epidemically pre- 
sent, is only extended by a contagion generated in the body ; 
but, even here, it would appear that there must be a condition 
of the air which increases the susceptibility of the human 
system to be impressed by the contagion, the disease being 
much more disposed to extend some years than it is in others. 

It is extremely improbable that any disease possesses a 
migratory character. We have no proof of such a fact. The 
term epidemic, in strict propriety, means a disease which 
spreads, and may be confined to one neighborhood, or extend 
to several ; but they do not pass over the broad seas, such as 
separate us from Europe. Webster says, " an endemic disease 
is one to which the inhabitants of a particular country are 
subject," and "the epithet is also applied to a disease which 
prevails in a particular season, chiefly or wholly in a particular 
place." The first explanation is the true meaning of the word, 
and it is in this sense only that it can be of use, since, if it 
means diseases which prevail in particular seasons, it would in 



EPIDEMIC CHOLERA. 



no respect differ from the term epidemic; and correct language 
has no synonyms. Modern language gives but a very limited 
use to the term endemic. Plica polonica, and the goitre of the 
Alps are specimens of what is meant by the word endemic. 



THE EPIDEMIC CHOLERA IS NON-MIGRATORY. 

The vast extent to which the influenza has been known to 
extend over the globe, has long since given rise to the sup- 
position, that a poison being generated in some part of the 
w T orld, may be spread by the winds over other countries. But 
that epidemic cholera does not cross the ocean, we think there 
is sufficient evidence. It is true that the epidemic of 1832, in 
the main aspect of its extension, has been westward. It 
entered Orenburg in July, 1829, since which its successive ap- 
pearance has been almost due west, till it terminated in Canada. 
If we were to look at this fact isolated from many others, we 
might conclude, that the cause of cholera had been wafted on 
to our shore ; but when we look at the history of the disease, 
we cannot admit such a supposition. Cholera has often existed 
epidemically at different places in the East Indies, and this is 
well known for near one hundred years. In Persia, it ap- 
peared several times. On the setting in of winter, it disap- 
peared, in one instance, at Astracan, and reappeared in the 
succeeding summer. The same disease appeared at Leeds, in 
England, in 1825, and it is said to have appeared at Vienna 
twice ; it existed at New London, N. E., in the winter of 1831-2. 
It has appeared at one town soon after it was known to exist 
at another, some miles distant, while the prevailing winds were 
contrary to its course in the direction that would favor its 
passing from the first point to the second. This was the case 
at Hamburg, and has often been seen in India, and of such 
facts we have taken notice in this work. 

But, notwithstanding that the sea between the west coasts of 
Scotland and Ireland, and Canada, are much frequented by 



EPIDEMIC CHOLERA IS NON-MIGRATORY. 81 

our vessels, the fisheries at Newfoundland banks lying between, 
and many vessels having left Europe, freighted with persons 
who had imbibed the poison, and suffered with the disease at 
sea, yet in no one instance has there been a case of cholera 
occurring on the high seas, so as to be brought to our shores 
affected with this disease. With such facts before us, nothing 
but preconceived opinions, formed without opportunity for ob- 
servation, can be brought to sustain any such conclusion. We 
may be asked, from whence have we the cholera poison ? We 
answer, that for the present, we have not been able to bring it 
tangibly to view ; but we have a condition of things which places 
this matter on grounds as satisfactory as that of almost any 
other grave subject belonging to medical science. We shall 
presently turn the attention of the reader to what we have to 
say on this interesting point. How can we conceive of a 
laboratory which shall generate a poison in India, or the more 
distant parts of Europe, sufficient to be carried by the winds 
over intermediate countries, and over the broad Atlantic ? To 
our apprehension, this is alone sufficient to disprove the belief 
that an atmospherical poison has come from the East .Indies, 
traversed parts of Europe, and afterwards filled this vast Con- 
tinent with the same material. 

We have already, in a preceding part of this work, taken 
some pains to point out the source of cholera fomites, but 
deem it proper to notice this subject briefly again. If we go to 
other countries, we shall find, as we do in our own, that cholera 
is almost entirely limited to low grounds, marshy places, or water- 
courses — in short, to locations where fevers, the acknowledged 
product of malaria, are indigenous, to this we may add, that 
wherever cholera appears epidemically, those fevers more con- 
genial to the place, if we may use the term, have previously 
appeared, and mostly at the same season of the year. This has 
been the case at several places, in the present year (1854), and 
many of those who died of cholera would have died of bilious 
fevers, common or yellow, according to location, &c. We have 
seen, in this work, that cholera appeared at Hamburg in nearly 
one hundred streets within one month. Surely, if this disease 
was infectious, so as to be capable of extending the poison, by 
6 



82 EPIDEMIC CHOLERA. 

personal contact, that city, and all others, might have been 
depopulated long since. Admit these premises, and it follows, 
that the malaria arising from the acknowledged material from 
which emanates the remote cause of our usual epidemic fevers, 
and we may safely consider the cholera as usurping the place 
of the more common occupants, and that the usurper obtains 
precedence by chemical affinities combining the elementary in- 
tegrants of the malaria, a well-known attendant of riversides, 
and is the offspring of vegetable putrefaction, &c. 

Everything, we think, conspires to disprove the belief, that 
the cholera poison came from the East, traversed parts of 
Europe, and then arrived in this country, and now fills a con- 
siderable part of this continent. Since we have no control 
over this specific matter, it is not very material whether we 
can or not ascertain its source, but we think, with Syden- 
ham, that the primary cause emanates from the earth. In 
briefly summing up the character of cholera, we view it as an 
epidemic, and of course dependent upon some atmospherical 
contamination for its predisponent cause, mostly confined to 
neighborhoods of moderate extent, but sometimes simulta- 
neously, or in near succession, in different places ; is most 
clearly non-contagious and non-migratory. 



THE NATURE OF EPIDEMIC CHOLERA. 

The most important point connected with cholera is a proper 
understanding of the relative nature of its cause. To illustrate 
this, we must advert to a few positions which will be admitted 
by most medical men. Some diseases are the product of 
specific causes; thus, we see that small-pox will produce small- 
pox — miasm will produce bilious fever, &c. These, then, are 
specific causes, because they always produce disease of one 
kind, as to genus, at least. But we have also fortuitous causes, 
and hence fortuitous diseases. Several individuals eat and 
drink too sumptuously, or use articles pernicious, but all eat 
the same ; presently, one is overtaken with a violent sick head- 



NATURE OF EPIDEMIC CHOLERA. 83 

ache, another has his accustomed gout, another has an attack 
of dysentery or common cholera morbus, another a mild diar- 
rhoea. Here is a specimen of a fortuitous cause and fortuitous 
diseases, and these diseases, so produced, may end fatally. 
Let us apply this illustration : a person, in an ordinary time 
of summer, eats unripe fruit, or the like, and has an attack of 
cholera morbus ; this is a fortuitous disease, for we have seen 
it might have been dysentery from the same cause, &c. ; but no 
one could think of fortuitous cholera becoming epidemic. How, 
then, does cholera become epidemic? By the operation of some 
general agent, and that general agent must be specific in its 
nature. It must have individuality or property, and that pro- 
perty being peculiar, is termed a remote or predisponent cause. 
If cholera morbus may occur from a fortuitous cause in ordi- 
nary times, may we not suppose that it may also occur in times 
of epidemic cholera, from a fortuitous or exciting cause, and in 
this way give rise to the belief that persons nursing those 
affected with the epidemic cholera, caught it from the sick ; 
and such a case may come in, to deceive those who are willing 
to admit a single fact to prove contagion or infection, in opposi- 
tion to thousands of things corroborating the non-contagious or 
non-infectious nature of the epidemic disease. We may remark 
here, that, in all seasons, and all places where there is malaria, 
there are many persons whose systems seem scarcely to be im- 
pressed with the poison ; and, in all specific diseases, the same 
as in small-pox, there must be susceptibility to the disease. In 
small-pox, the susceptibility is destroyed by the action of the 
disease upon the system ; and something of the same sort ex- 
ists in fever and epidemic cholera, at least for certain periods ; 
otherwise, persons who had recovered from an attack would be 
seized again, upon going out to breathe the same sort of 
malaria that produced the attack. As regards small-pox, this, 
too, has its peculiarities, for there have been epidemic seasons 
when people were more liable to the disease than in some others. 
We suppose that susceptibility is as necessary for the pro- 
duction of cholera as the exciting cause, and we everywhere see 
more or less of the people escape ; some have slight attacks, 
and, in all severe epidemic diseases, there are some malignant 



84 EPIDEMIC CHOLERA. 

cases, not even excepting influenza. We shall presently see, that 
this view of the subject is highly important, and calculated to 
obviate one of the greatest difficulties, we think, in the whole 
phenomena attending epidemic cholera. We are told by different 
writers, that in many of the cities (perhaps in all), there was 
a great number of slight disease of the stomach and bowels 
while the cholera prevailed, and generally before there was 
any alarm ; many physicians do not consider these as being 
cases of cholera. These harbingers were seen at Orenburg, St. 
Petersburg, Sunderland, in Canada and New York; and at the 
present time (1832), there are perhaps thousands of cases of 
these forms of disease in Philadelphia, and to an extraordinary 
extent in Baltimore ; and, in intermediate places, much of the 
same was to be seen. And many physicians tell us, that simul- 
taneously with epidemic cholera we have dysentery, common 
cholera morbus, and diarrhoea of all grades. Now, if it be ad- 
mitted that the malignant cholera is an epidemic, to what, 
agreeably to any rules of reasoning, can we ascribe the milder 
cases', but to the same cause ? either in a less concentrated 
state, or modified by the habit of body ; for, in addition to the 
necessity of the presence of a condition of susceptibility, there 
is always required some exciting cause, as fear, fatigue, watch- 
ing, mental perturbation, intemperance in eating or drinking, 
or both, or excess in venery. 

To our apprehension, we may as well take up the intellect of 
Bacon, or Newton, and say that none are men who do not come 
up to their standard of intellect, as to say that because the epi- 
demic cholera, under certain circumstances, becomes malig- 
nant, none can be cholera but such as come up to this standard. 
It is known that great epidemics rule, so to speak, in the do- 
minion of diseases ; that a great epidemic once set up, all dis- 
eases assume more or less of its livery ; and shall we, notwith- 
standing this law, have three epidemics prevailing at the same 
time and in the same place ? Such a condition of things is not 
admissible, seeing that we could not easily imagine how three 
poisons should exist in the air at one and the same time; and 
the general prevalence of diarrhoea, or what we term cholerine, 
and cholero-dysentery, shows these diseases to be epidemical. 



NATURE OF EPIDEMIC CHOLERA. 85 

We believe that wherever cholera prevails epidemically, and 
both before and during the recurrence of malignant diseases, the 
stomach and bowels, in particular, of almost every individual 
in the neighborhood, are impaired more or less, and require a 
guarded use of whatever is difficult of digestion, and caution in 
not eating too freely of anything. With all care, we shall 
have much diarrhoea of various forms, and these affections, the 
usual forerunners of cholera lethalis (or cholera major), are 
easily cured, when early attended to. It is our settled con- 
viction that, instead of one-half or one-third of cases of cholera 
terminating fatally, there is not, in any epidemic of this sort, 
one fatal case in several hundreds, 

We might go on and show that there is no disease uniformly 
malignant. It is known, notwithstanding the great mortality of 
the yellow fever of 1793, in Philadelphia, that there was many 
cases of bilious fevers of the remittent and intermittent type, 
and over a greater extent of the city than ever before or since. 

This state of things is present wherever yellow fever is epi- 
demic. We see small-pox, with its stable character, presenting 
some mild cases ; but, in the main, it is a disease of great mor- 
tality. The cholera, in the main, is a disease of mild charac- 
ter, but presents, now and then, some very malignant cases. 
There is a period, though sometimes very short, in which 
almost every case of cholera can be arrested ; how this is to be 
done, we will endeavor to point out when we come to speak of 
the treatment of this disease. 

In summing up our views of epidemic cholera, we say, it is a 
specific disease, depending on a predisponent cause, which is a 
poison floating in the atmosphere, or existing as an occult prin- 
ciple, that, therefore, there is but one genus, one species in 
cholera; but there are three well-marked stages: these stages 
may be more or less blended, or changed from the milder to 
the malignant, and, being epidemic, are different from common 
cholera morbus, which arises from a fortuitous cause. We see 
the disease sometimes very much resembling bilious fever. 
We may also observe, that, in every season of epidemic yel- 
low fever, cases of common cholera morbus are seen, but they 
are sometimes from a fortuitous cause. 



bb EPIDEMIC CHOLERA. 

To make ourselves clearly understood, it is necessary to say 
a few words respecting existing causes under this head. In- 
formation from all countries contributes to show that cholera 
does not very often assume its malignant form, except in the in- 
temperate, the impoverished, and unclean, or some aggravated 
exposure or infirmity. The epidemic cholera and the common 
sporadic, from surfeit or indigestion, do not present anything 
anomalous in so nearly resembling each other. Cases of these 
diseases agree in this only, that in both instances the same 
parts of the body are diseased ; the causes are widely different, 
and yet the symptoms have resemblance, because the same 
structures are involved. We see phenomena similar in small- 
pox and other diseases; thus a patient, in the primary fever, 
has all the symptoms of severe fever, bilious or inflammatory, 
and it is not until the small-pox presents its pustulation that 
we recognize its true character. The circumstances attending 
epidemics are nearly the same in the single individual, and we 
can only recognize it by its malignant aspect : but the peculiar 
symptoms of which this malignancy is constituted being epi- 
demic, characterizes cholera major as completely as the erup- 
tion of small-pox characterizes that disease, so that a few ma- 
lignant cases, with many that are milder, establish the epidemic 
character of cholera major, and the absence of malignant cases, 
without those peculiar symptoms, establish the character of 
cholera morbus. And it seems in place to remark here, that, 
in a practice extensive and of more than forty years' duration, 
we never, within our recollection, lost a case of cholera morbus, 
except where it appeared as the prominent symptom of yellow 
fever, and those cases occur very seldom. 

We are as ignorant of the mode of invasion of the choleraic 
poison as we are of its origin. The most rational view of the 
subject is, that it enters through the medium of the lungs. 
We are not disposed to speculate upon things which seem to 
elude or transcend our means of inquiry or observation. Pre- 
monitory signs have preceded all instances of the malignant 
cases of cholera major, and from the vast number who have 
the disease mildly, and that few, comparatively, have the ma- 
lignant symptoms of this disease, who live as they should do, 



NATURE OF EPIDEMIC CHOLERA. 87 

we are warranted in saying that the poison is mostly in a very 
dilute state, and operates for some time upon the system before 
the malignant condition is produced. 

Whatever may be its mode of invasion, we find that the de- 
rangement arising from the operation of cholera fomites mostly 
is first perceived in the stomach and bowels, especially the lat- 
ter ; these structures are interrupted in the ordinary secretory 
and assimilating operations, these functions being dependent 
upon the splanchnic system of nerves, with the ganglionic cen- 
tres ; this nervous apparatus is disturbed in its economy, and 
mutual derangement takes place ; while the nerves are irritated 
by the ingesta, the grand sensory is disturbed in its function 
by the surgelation of the encephalon with blood, and that blood 
of an abnormal quality. 

It is known to physiologists that it is not more necessary 
that we constantly inhale the atmospherical air, than that the 
operation for the supply and repair of waste and impairment 
of our bodies be incessantly going on. And in milder cases, 
'or in the first stage of cholera, there is an interruption of the 
digestive and assimilating apparatus, and this gives rise to 
cholera in all its aspects. Arrest the morbid actions before 
the sensorial energies and the accretive fluids are materially 
impaired, and your patient recovers ; suffer the impairment to 
go on to a certain amount of derangement, and extreme danger 
or death will be the result. No animal among the higher 
orders can exist unless the necessary plastic operations are 
momentarily maintained — speedy death will take place; when- 
ever that nervous energy, which controls the inmost assimila- 
tion of the system, fails in its office, we shall have disease of 
more or less violence, or death, according to the degree of sen- 
sorial disturbance. 

In the case of an epidemic choleraic contamination of the 
atmosphere, pathological observation shows that the head be- 
comes surcharged with blood, which has been shown in this work, 
in the chapter containing the dissections at Hamburg and 
other places. And this surcharge of the brain is so constantly 
present after death, that we may safely conclude that this 
condition prevails during life ; the more so, when we see the 



88 EPIDEMIC CSOLERA. 

total disruption (if we may use the term) of the blood through- 
out the sanguiferous system ; for we believe that the economy 
of no structure, in the animal system, is more truly vivific than 
that of the blood as it stands in its multiform relations. 

There appears to be good reason for supposing the first link 
in the catenation of abnormal actions in the phenomena at- 
tending cholera, is the great sympathetic system, distributed on 
the mucous surface of the stomach and intestines. This is no 
assumption ; we see a remarkable connection between the brain 
and the stomach in cases where a person in good health is 
about to satisfy hunger, and some very distressing or alarming 
news comes to hand, appetite is totally banished. Here, then, 
is an important indication. And we see that, in cases of out- 
breaks of cholera, how important is tranquillity of mind, and 
moderation in our diet. Impose as little duty upon the diges- 
tive organs as is consistent with health, remembering that too 
low a diet may also disturb the economy of the system. Take 
nothing into the stomach that is hard of digestion, or apt to 
impair the digestion by its quality or quantity. We shall, 
when we come to treat of the epidemic which prevailed in Bal- 
timore in 1832, show that fruits and articles that are usually 
eaten raw, did, in an especial manner, disagree, and often the 
using of such articles was followed so quickly by the most violent 
symptoms of cholera, as to leave no room to doubt the unfitness 
of such articles. 

It has been found by experience that certain things relating 
to food, drinks, the condition of our dwellings and premises 
generally, facilitate the inroads of cholera, and gross abuse of 
such things not only invites the disease, but gives to the specific 
poison, by which the disease is constituted, all its malignancy. 
Here we have a clear indication in guarding against seizure, 
and we are made sensible of the goodness of the influence of a 
kind Providence of a condition, in almost all epidemic diseases, 
that will enable very many to ward off the complaint. In cholera, 
thousands may inhale the poison which gives rise to that dis- 
ease, and they suffer nothing but a temporary derangement of 
health, provided they have recourse to precautionary measures, 
by avoiding certain things, such as fear, or excessive exertion, 
whether by mental or corporeal activity, loss of sleep, &c. 



NATURE OF EPIDEMIC CHOLERA. 89 

The foundation on which we may rest the phenomena at- 
tendant upon cholera, is a reduced energy of the distributive 
portion of the sensorial organs. This reduced state of the 
nervous energies gives rise to a morbid or preternatural irrita- 
bility and sensibility, and this is generally of such a nature as 
not to lead to a state of reaction, or much ordinary febrile ac- 
tion. On the contrary, the essential nature of cholera is, that 
its early stage depends upon reduced energies of certain por- 
tions of the distributive apparatus of the sensory, and this 
reduced state of the energies leads to spasms — a mere symp- 
tom ; but we have elsewhere said that the intrinsic nature of 
cholera is impairment of the vis a tergo, which term, however 
ancient, conveys to my mind the existence of a power of pro- 
pulsion, which gives play to distributive sanguification. When- 
ever propulsion of the blood ceases, the animal body speedily 
falls into ruin. 

It has been imagined by some physicians, notwithstanding 
the conviction that what is usually called the remote cause of 
cholera is in the surrounding air, that, nevertheless, under 
certain circumstances, a poison may be generated in the human 
body which shall have the same properties as the atmospheric 
poison, and in this way the disease becomes contagious or in- 
fectious. We think this would be contrary to the laws of 
nature governing chemical combination. How can we sup- 
pose that certain elementary matter, produced by an elimi- 
nation from the surface of the ground, or an atmospherical 
poison gives rise to a certain disease, and, at the same time, 
imagine that a poison exactly similar may be produced by or 
from the living actions of the animal body? Such a supposi- 
tion is contrary to sound rules of reasoning, which do not 
admit of similar productions from dissimilar elements or dis- 
similar causes. Let us admit, for the sake of illustration, that 
a poison has entered the system, and the body generates an- 
other; here, according to all our notions of generation or 
production, the extraneous matter is one parent, and the body 
acted on gives another, can we suppose that the offspring or pro- 
duct will be similar to the former ? Does not everything show 
us that parents of dissimilar kinds will produce offspring dif- 



90 EPIDEMIC CHOLERA. 

fering from both ? Nature has been sparing, indeed, in the 
production of hybrids or mules, and invariably unnatural 
generation produces offspring having properties sui generis. 
If a poison be generated, and given off by the animal body 
during the existence of cholera, that poison will be as likely 
to produce almost any febrile disease as cholera. Epidemic 
cholera can have but one cause, like all other specific diseases, 
nor have we any half contagions or infections. 

There is a mass of testimony in favor of the non-contagious- 
ness of cholera, which is not to be upset by a few cases brought for- 
ward, now and again, which present strong features of the oppo- 
site ; but surely it is the safest course to adopt, i. e., that it is not 
infectious. How can we believe that, in large cities, the disease, 
when it once gains force sufficient to excite alarm, can pass 
away in a few weeks : the atmosphere is impregnated with the 
material that all must acknowledge to be the exciting cause of 
epidemic cholera, and yet we are asked to believe that it passes 
from body to body. The matter giving rise to cholera is, as 
far as we know anything positive of its nature, of out-door 
origin, and cannot be begotten by the living economy, whether 
in health or sickness of its subjects. It is one of the properties 
of this poison, that it never exists long in the same place ; about 
two months, we think, is its most usual period in large cities; 
there have been exceptions: it has sometimes lasted three or 
four months ; but there has been very many instances where 
cholera has appeared with appalling virulence in small towns, 
and disappeared in two or three weeks after the fall of, per- 
haps, half a dozen, a little more or less, of its victims. And 
we view this as strongly corroborative of its non-contagious- 
ness. If the disease can only exist while there is atmospherical 
contamination of a peculiar kind, how can we suppose it to 
cease while nurses, physicians, and neighbors, do the offices 
necessary for the welfare of the sick ? Small-pox presents a 
very different state of things ; for, despite the benefits of vac- 
cination, this disease has existed more or less in London ever 
since the Jennerian discovery. We repeat, the cause of cholera 
is atmospherical, being a poisonous principle, electro-choleraic 
probably. This poison is generally so slightly diffused as to beget 



PUBLIC MEANS FOR PREVENTION OF CHOLERA. 91 

a predisposition or a susceptibility only, and requires the co-ope- 
ration of malaria, and the combination operates with deadly force. 
Long continuance of a mild impression, or fierceness of one that 
is short, gives rise to a period when an explosive train is laid, 
and nothing but the match is wanting. With this state of things 
we are sometimes surrounded. A debauch, an over-meal, an 
alarm, great fatigue, loss of rest or sleep, eating of indigestible 
articles, in short, whatever is in any way in excess, may give 
the impulse ; and now is seen the destroying disorder which, 
in almost every case, is only to be cured before the vital pro- 
perties of our bodies is laid waste, and no longer fit for 
animating the living frame, nor susceptible of restoration. 



PUBLIC MEANS FOR PREVENTION OF CHOLERA. 

Of the public means, it may be remarked, in the first place, 
that the history of the disease, for a series of years, supports 
the belief, that low or marshy, and crowded and filthy situa- 
tions, are most subject to cholera. The lower part of towns, 
particularly where streets, lanes, and cellars are filthy, and 
along the margin of rivers, &c. In short, in locations where 
diseases are apt to prevail which have for their cause malaria 
or miasm. But, notwithstanding the certainty of this obtaining 
generally, there are some exceptions, where the disorder affects 
towns, or districts of country, in which miasmatic diseases do not 
prevail. Cholera is generally arrested, like bilious affections, 
by winter seasons; but there are a few exceptions. But, in 
what department of secondary operations in nature do we see 
absolute uniformity? It is characteristic of this disease, that 
persons of good or regular habits are much less subject to it 
than those who disregard the claims of cleanliness, and who par- 
take of sensual indulgences ; and this, we believe, is corrobo- 
rative of the non-contagiousness of the malady before us. Does 
small-pox, or any other acknowledged contagious disease, look 
for persons of filthy or faulty habits ? We are aware that 



92 EPIDEMIC CHOLERA. 

small-pox has also some preferences in this respect ; but it is 
as nothing compared to the universality of the freaks of epi- 
demic cholera, and all this is in favor of the opinion that the 
general atmosphere is the source of cholera. 

We should avoid crowded assemblies in epidemic times, and 
particularly during the presence of that which is the subject of 
this work. Our countryman, Noah Webster, has, many years 
since, pointed out the evil which frequently arises in crowded 
assemblies, in our legislative halls ; and we have observed, some 
years ago, that the Legislature of Maryland suffers much from 
affections of the chest and throat, although their halls are quite 
spacious, and we believe it is owing to the collection of im- 
pure air, arising from too many lungs operating upon the air 
of the halls. We have elsewhere endeavored to show that the 
malaria, which is required for the production of cholera, may 
probably be generated in the body. 

In times of epidemic cholera showing its precursors, — (for 
these harbingers, we believe, are seen ninety-nine times in the 
hundred,) — people should not be suffered to crowd into small 
houses, nor should more than a reasonable number occupy 
larger houses. At such times, and, indeed, at all times, it 
would be the interest of the rich landlords to guard against 
this evil. Dilapidated and rotting houses should be removed, 
and better put into their places. All such improvements would 
be conducive to health, as regards febrile diseases in general, 
as well as in relation to cholera. We here, in 1832, in our 
journal, anticipate the English Board of Health for 1854. 

The precincts of cities are almost always unhealthy, which 
is mostly owing to filth arising from manufactories, drains, 
ponds, &c, and much of the evil thence arising could be ob- 
viated by proper attention to such locations, removing such 
things as are most objectionable, and keeping everything clean. 
It has been seen that persons who occupy low dwellings, cellars 
in particular, are very liable to cholera ; it follows that these 
situations should be avoided, especially at night ; all persons 
should, therefore, as much as possible, occupy upper rooms at 
night. Too much pains cannot be taken to keep clean every 
lane, alley, court, street, yard, dock, cellar, lumber-yard, privy, 



MEASURES OF PREVENTION OF A PERSONAL NATURE. \)6 

&c, and when everything offensive is removed, lime should be 
freely used, — the common acts most durably, the chlorides of 
lime and soda act more speedily, but of course less permanently; 
cellars should be well cleaned and whitewashed. In times of 
danger, soap should be distributed to the poor, and the proper 
authorities should see that they keep clean their clothes, their 
persons, and houses. Where the clothes and bedding are dis- 
gustingly filthy, they should be burnt, for here malaria may 
be generated. 

Offals and perishable vegetables should be carefully watched 
and removed, whenever they become tainted. A great deal of 
evil would be prevented in cities if refuse matters were more 
generally burnt, instead of letting them accumulate in heaps, 
or throwing them in the streets. This is a valuable suggestion 
of Dr. Rush's. We may have overlooked some things equally 
important with these we have pointed out, but enough has been 
said under this head to enable every one to see what is likely 
to be hurtful. 

Among the measures preventive of cholera, we would notice 
the speedy removal of the poor from neighborhoods in which 
the disease seems most to prevail. It seems to be known, that 
in a majority of instances of epidemic cholera, the malignancy 
of the disease has been confined chiefly to particular neighbor- 
hoods, and removal can, therefore, sometimes be effected, much 
to the relief of the poor and those who provide for them. 

MEASURES OF PREVENTION OF A PERSONAL NATURE. 

The first thing which presents itself here is the increased 
liability to cholera from fear. It being a well-attested fact 
that many persons suffer from this cause, too much pains 
cannot be taken by every one to regulate their conduct, so as 
to guard, as far as possible, against it, and endeavor to quiet 
the apprehensions of the timid. All extremes should be 
avoided ; we should live abstemiously, partaking generally of 
what we have been accustomed to, or rather what we know to 
agree best with our stomach, but guarding against too much 
variety on the same day. Instead of overloading the stomach, 



94 EPIDEMIC CHOLERA. 

we should take care to eat and drink so as to give the stomach 
full opportunity to digest, and send away well prepared what 
is taken in. Persons, in general, should abstain wholly from 
spirits, wine, malt liquors, and every drink, except water, and 
not too much of that made cold by ice. Those accustomed to 
dram-drinking or drunkenness should daily diminish the quan- 
tity of stimulus. Physicians and public men, who visit sickly 
places, or whose duties require great exertion, should be careful 
to avoid too much fatigue, or night- watching ; if done as a 
source of profit, no more than a reasonable amount of labor 
should be performed. If humanity demands it, the best results 
will attend a fair share of labor only ; for, by over-exertion, the 
actors become victims to the disease, and they may leave a 
void, to the detriment of the community. 

Pains should be taken to keep the body clean, and bathing 
two or three times a week will conduce to health ; but too fre- 
quent dabbling in water, warm or cold, we think, will be hurt- 
ful, and the object being cleansing, persons should not remain 
in the bath longer than is necessary for that purpose. Avoid 
the night air and crowded places, also sleeping in lower rooms, 
or sleeping in small rooms. Nothing, perhaps, is more dan- 
gerous than overloading the stomach ; too much exertion in the 
hot sun, and drinking rashly of cold water, when much heated, 
whether by the sun or labor. 

It has been said by Sydenham, that more people die from 
the effects of cold upon the human body, than perish by pesti- 
lence, war, and famine ; and Rush has advised, as a rule, that 
we dress rather too warm than too thinly ; and it has been re- 
marked by different writers on cholera, that attention to cloth- 
ing is all-important. In changeable weather, we should en- 
deavor to conform to the more remarkable changes, especially 
we should wear a belt of flannel or coarse muslin. Strict at- 
tention to the foregoing precautionary measures will afford 
much security; and whenever exposed to a choleraic atmo- 
sphere, we should be moderate and regular in all things, re- 
membering that we are in some degree invalids, seeing that 
while the atmosphere disposes the body to cholera, there are 



SYMPTOMS OF EPIDEMIC CHOLERA. 95 

many things about us that lead to or from the disease ; as we 
shall choose to avoid or approach, so will be mostly our lot. 



SYMPTOMS OF EPIDEMIC CHOLERA. 

In entering upon this subject, it becomes necessary to re- 
mind our readers of the view which we presented when speaking 
of the nature of epidemic cholera, i. e., that there is only one 
disease, but three different stages of it. To illustrate this part 
of our subject, we shall not stop to notice the different names 
that have been applied to the malady, as Asiatic, Russian, or 
spasmodic. These names are founded on accidental circum- 
stances, and do not serve to characterize the disease. The re- 
markable degree of sinking, which attends all malignant cases, 
would serve to express the condition then present; but when 
we take a view of the whole subject, we readily see how illy 
adapted is the term asphyxia, to express the whole career of a 
case of cholera. The truth is, no one name can be applied 
which will serve to express the character of the disease. Epi- 
demic cholera signifies its most prominent and steady trait, 
therefore it should have the preference. 

We have been led to consider epidemic cholera as the most 
suitable epithet for the disease under consideration ; and the 
disease appearing in different stages, but being the result of 
one cause, we opine the most judicious arrangement which we 
can make of the subject is to distinguish the disease by the 
term epidemic cholera, and divide into different at&ge&cholerine, 
cholero-dysentery, and malignant cholera, or cholera lethalis. 
We are informed by physicians, who saw the epidemic at Oren- 
burg, St. Petersburg, Sunderland, Montreal, New York, Ham- 
burg, Philadelphia, and much of the same in Baltimore, that 
diarrhoea, and other bowel affections, also affections of the 
stomach, prevailed pretty extensively some time prior to the 
outbreak of cholera. So true was this, in Baltimore, that these 
milder stages prevailed for some weeks before the epidemic as- 



96 EPIDEMIC CHOLERA. 

sumed its malignant aspect, and, while it raged, the mild stages 
of the disease bore a vast majority over those that were 
malignant. 



OF THE CHOLERINE STAGE OF EPIDEMIC CHOLERA. 

This usually begins with sick stomach, sometimes vomiting, 
and a sense of tension around the abdomen, and about the 
stomach, more or less purging, sometimes severe ; the matter 
vomited is mostly of a bilious nature at first, sometimes acid ; 
and when the vomiting is not soon checked, the matter ejected 
or passed by stool is watery or slimy. The first discharges 
from the bowels are often, at first, in greater part faecal, then 
bilious ; in some instances, they had some resemblance to coffee- 
grounds. Most patients spoke of the stools being watery, some- 
times light-colored, sometimes, but seldom,- dark. In most 
cases, the discharges, both upwards and downwards, were less 
copious than in most severe cases of common cholera morbus, 
in one case of exception we were assured that several quarts 
had been passed in one night. 

We did not find arterial excitement which seemed to require 
the lancet, but we sometimes found the skin warm, with some 
febrile action in the system. In all these cases, the tongue 
was thickly coated with a yellow fur ; the head was seldom 
affected with pain or distress ; respiration not disturbed ; pros- 
tration not great ; stomach much disposed to reject such medi- 
cines as were given. Some cases — most, indeed, were attended 
with cold skin and clammy perspiration; in these cases the 
arterial action was a good deal reduced, and the tongue had 
mostly a thick white coating. The speed with which other 
symptoms abated upon using remedies, was not more remark- 
able than the clearing off of the tongue ; we have seen the 
tongue extremely foul, and on the second day afterwards, it 
has been perfectly clean — a sure indication always of a mild 
disease. 



MALIGNANT STAGE OF EPIDEMIC CHOLERA. 97 



CHOLERO-DYSENTERY STAGE OF EPIDEMIC CHOLERA. 

This form of the disease was pretty generally attended with 
the symptoms belonging to cholerine. The most remarkable 
peculiarities were greater arterial action, a deeper yellow coat- 
ing of the tongue, as the predominating cast. There was often 
pain and heaviness of the head ; sometimes sickness at stomach, 
mostly but slight; and we never saw anything like severe 
vomiting. The alvine discharges were small, and consisted 
principally of mucus, streaked more or less with blood ; in a 
very few cases the discharge of blood was considerable. "We 
saw one case of severe vomiting of blood. We met with a few 
cases of this stage of the disease which required one pretty 
free bleeding, never more ; the cleaning off the tongue was 
equally remarkable as in cholerine. 

We should come near to a true view, as regards medical 
treatment, by viewing cholerine and cholero-dysentery as mild 
cases of common cholera morbus and dysentery proper. We 
did not see a single case in which we were apprehensive of 
danger, and we saw but few cases that became protracted for 
several days. In most cases of cholerine and dysentery, the 
patients recovered in two or three days, sometimes in a few 
hours. Our patients were nearly all adults ; indeed, it has so 
happened (1832), that we have had less cholera infantum 
than usual during the reign of cholera. 



THE MALIGNANT OR LETHALIS STAGE OF EPIDEMIC 
CHOLERA. 

The following case, which occurred at Hamburg, is one of 
the most perfect cases that can be found. Those conversant 
with diseases must be aware of the great irregularity of symp- 
toms in most diseases, and in epidemics more especially. We 
need not dwell upon this point, further than to cite the fact, 
with a view of illustrating our opinion, with respect to the cir- 
7 



98 EPIDEMIC CHOLERA. 

cumstance that, notwithstanding the diversity of symptoms, 
every disease is characterized by certain pathognomonic symp- 
toms, and as the case shall present more of these signs, so 
shall it be more pure or perfect of its kind. In this way we 
get a sort of standard which serves to distinguish one disease 
from others ; and, although we meet with many anomalies, still, 
all that present certain signs are referable to some one disease ; 
and, as the signs shall more or less resemble the standard phe- 
nomena, so is it more or less perfect. We present the follow- 
ing case as one of the most perfect cases of malignant cholera, 
and, being so, may serve to characterize the disease, provided 
we notice a few anomalies, which we shall do as we proceed. 
The case in view has been noticed in our translation of Dr. 
Fricke's pamphlet on cholera at Hamburg ; but we deem the 
case of so much importance as a genuine case of this malady, 
that we have thought proper to repeat it here. 

This was the case of Anna Garrasen, aged thirty-five years, 
and an occupant of a deep cellar. She sickened on the 10th 
of October, 1831, and was taken to the cholera hospital. The 
day before her attack she was quite well, and slept well the 
night before it. She was seized with violent purging and 
vomiting, and very severe pains in the abdomen. When she 
was admitted, the whole body and the tongue were ice-cold ; 
the face looked as if frozen ; the hands were blue with cold ; 
the eyes deeply sunken in ; the tongue coated whitish, but was 
moist; the pulse imperceptible; purging and vomiting con- 
tinued ; alvine discharges thin and colorless ; great anxiety ; 
violent cramps, particularly in the feet ; much distress about 
the precordia, especially towards the back. She was imme- 
diately subjected to an alcoholic bath, at the temperature of 
35° R. The skin became moist, but not warm. By making 
four large orifices in the arms, about half a pint of thick, tar- 
like blood was obtained. An hour afterwards, she thought 
herself much better, but had great distress about the precordia. 
The spasms, the vomiting, and purging went on ; the skin now 
a little less cold, but there was cold sweat ; expression of face 
a little improved. 

Evening. 6 o'clock. The face a little warmer, and not so 



MALIGNANT STAGE OF EPIDEMIC CHOLERA. 99 

much of the expression of extreme coldness, and covered with 
a warmer perspiration ; countenance improved, and less cha- 
racteristic of choleraic distortion ; voice improved ; no purging 
nor vomiting ; tongue coated white, and is moist and warm ; 
respiration more free ; sinapisms produced great suffering ; 
pulse barely perceptible ; legs warm to the knees, below quite 
cold ; frequent spasms, but less violent than they have been. 
The great pain attending the effects of the sinapisms, requires 
a passing notice. Dr. Diffenbauch says that, however reduced 
the circulation, the sensibility of the skin is not lessened. 
This may sometimes call for especial attention, so that we do 
not add to the prostration of the patient, by the pain from ex- 
ternal stimulants. In our own person, in a state of great 
prostration from bilious fever, mustard was applied to the epi- 
gastrium, and the pain had a most prostrating effect, and if the 
mustard had not been taken off speedily, syncope would have 
taken place, from which, we believe, great danger might have 
arisen. 

October 11th. Day after admission. The patient has had 
but little sleep, and has vomited and purged several times ; the 
cramps less frequent ; has voided no urine ; the upper part of 
the body covered with sweat ; the lower extremities cold ; the 
hands livid and cold; fingers drawn inwards; pulse imper- 
ceptible. She had taken some very small doses of calomel 
yesterday, and, besides the alcoholic bath, warm jugs were ap- 
plied. At noon the symptoms have become worse, in addition 
to pulselessness and laborious respiration ; the whole body is 
ice-cold, and the hands livid. The alcoholic bath was used at 
35° R., and she remained in 25 minutes, and felt better ; the 
skin again became moist, but in an hour after this, she pre- 
sented the aspect of a person in typhus fever, and death came 
to her relief at 3 o'clock, thirty-three or four hours after the 
attack. 

In the case of Anna Garrasen, we have a real malignant dis- 
order, remarkable only for not having been preceded by chole- 
rine or dysentery. It is said she slept well the night before 
the attack. This may have been so, but great doubt exists as 
to the accuracy of the answers of people of her condition and 



100 EPIDEMIC CHOLERA. 

habits. All diseases, however, occasionally present anomalies, 
and one occurring here would not invalidate the almost uniform 
opposite. We have already given an account of the epidemic 
cholera at Hamburg, and its first irruption in that city, and 
we have there detailed the result of a number of dissections 
among them, that of Anna Garrasen, to which we refer. 

The cholera at Hamburg and other places in Europe, 1831, 
was attended by a strong tendency to turgescence in the head, 
and this in a greater degree than obtained in Baltimore in 1832, 
and through other parts of the United States. We were assured 
by several physicians of eminence, in Germany and in Sweden, 
that in all febrile diseases in those countries the brain suffers 
much; "So much so," said Dr.Westring, of Gotheborg, "that the 
theory of Clutterbuck would come nearer the truth than that of 
Broussais." But we have seen, we think, a much greater ten- 
dency to the brain in the present year (1854) at Columbia, 
and in perhaps five or six cases at York, Pennsylvania, in 
which there were symptoms showing such a condition. We have 
not seen any dissection of these cases. These patients gene- 
rally retained their senses till almost the last moment of their 
existence ; but there is a marked indifference as to the issue 
when the case is far advanced towards the fatal termination. 
This symptom serves strongly to characterize epidemic cholera, 
and comports with the appearance of dissections at Hamburg, 
the cerebellum and base of the brain being much more sur- 
charged with blood and serum than the cerebrum. 

In almost every case of dissection after cholera, there has 
been observed an absence of bile in the intestines, and a quan- 
tity of it in the gall-bladder, so much, often, as to render that 
viscus turgid, and bilious matters are sometimes seen passing 
from the intestines in cholerine, and cholero-dysentery ; this 
is merely what happens to be present in the intestines at the 
time of the seizure, and when that is passed off the discharges 
become of a light or whitish color; but as the disease advances, 
the discharges become more serous, more copious, and they 
have the appearance of whey or rice-water, attended with sink- 
ing prostration, cramps in the lower extremities or abdomen, 
and we have now a most -critical stage. It is now that half an 



MALIGNANT STAGE OF EPIDEMIC CHOLERA. 101 

hour or hour, perhaps sometimes less, that the issues of life 
and death are thrown, as it were, upon an equipoise, and the 
preponderance is on the side of death ; but even at this point 
some cases may be arrested. 

We mean here by the term malignant, a state of deadliness, 
and of a general lethalic nature, something like what we see 
in yellow fever and in typhus gravior ; the malignancy in 
cholera seems to consist in a suppression of the action of the 
sensorial apparatus, by which the blood deteriorates, and is no 
longer fit for sustaining the intrinsic operations of the circula- 
tion. A state of asphyxia gradually approaches, and, once pre- 
sent, death is at hand ; for the circulation being in a great degree 
suspended, can almost never be restored, because the blood has 
lost both its vital properties and its wonted fluidity. Asphyxia, 
we are aware, may exist as a disease, as was seen in the case 
of John Hunter. This great man was affected with a disease 
of the heart, and was known to lay the better part of an hour 
pulseless, and would then revive. In these cases we may sup- 
pose that the heart and other organs resume their office after 
being suspended for a short time, because the blood is in a 
healthy condition, and the brain free from turgescence. But, 
in the last stage of cholera, there is a deadly tendency to un- 
equal distribution of the blood ; among other evils, coagulation 
often takes place, nor must we forget the important part the 
retention of the urea in the blood bears in the train of evils. 
The heart failing in its function, the capillaries, the lungs, the 
kidneys, are crippled, and add to the degenerating tendencies, 
and there is nothing left to second the efforts of the physician. 
We have already pointed out the precautionary measures, 
both public and personal, in this work, that are necessary to 
be observed with a view to prevention. So much depending 
upon these precautions, we shall make a few remarks before 
entering upon our account of the epidemic cholera of 1832 in 
Baltimore. Let every one, who can conscientiously do it, en- 
deavor to impress on the minds of the ignorant and the timid 
that there is no other than a mild poison to fear, and that too 
much pains cannot be taken to render the disease mild and 
safe. It should be remembered from day to day, and from 



102 EPIDEMIC CHOLERA. 

hour to hour, that this poison renders every one, in some de- 
gree, an invalid, and that the impairment is in the digestive 
function, as we hope we have proved in these sheets. We 
must not only live carefully, as regards quality, but we must 
live abstemiously. Those who are aware of the vast advan- 
tages that were obtained by strict abstinence in the inoculation 
for small-pox, can readily appreciate the necessity and advan- 
tage of pursuing a similar course in the present instance. In 
the time of the epidemic in Baltimore, in 1832, we (the writer) 
reduced the quantity of our food at least one-half, and observed 
much greater simplicity in the selection than usual. There 
may be persons whose systems are in a reduced state, who had 
better improve their diet, and they will be benefited by the use 
of a little increase in animal food. The substance of what we 
have written at present, 1854, was written and published in the 
year 1832, and contains every precautionary measure set forth 
by the English Board of Health for 1854, as published in the 
Medical News of Philadelphia. We shall, however, postpone 
our notice of that paper and the review of Dr. Berg's report 
on cholera in Sweden in the year 1850, until we shall have 
given our account and our observations on the great choleraic 
epidemic in Baltimore in the year 1832. 



EPIDEMIC CHOLERA IN BALTIMORE IN THE YEAR 1832. 

There is an old saying, that "an ounce of prevention is 
better than a pound of cure;" admit this, as a truth, and it is 
but a mite in comparison with the disparity between the means 
of cure of epidemic cholera and the prevention of it. Enter- 
taining these views, while we acted as consulting physician for 
the city of Baltimore, we never lost sight of the importance of 
the advantages that were to be derived from the constant ap- 
plication of preventive measures. 

Our attention was early awakened to the breaking out, 
the advances, and the character of cholera, as it made its ap- 
pearance more and more near to our country and to our city. 



CHOLERA IN BALTIMORE IN 1832. 103 

We shall suspend our observations of a directly medical cha- 
racter, to make way for a brief historical account of the disease, 
and the measures adopted by the city authorities in anticipa- 
tion, with the view, as far as possible, of being ready. 

By this sketch, we hope to prove that the authorities, alive 
to every sense of humanity, spared no pains to prepare means 
of defence, and that it was their good fortune to be instrumen- 
tal in adopting the most salutary measures of which the case 
admitted. 

We are aware, that, among the many attempts that have 
been made to throw light on the truly important subject before 
us, there has been a redundancy of commonplace matter ; but, 
after all, we apprehend that this was the most ready and best 
mode of acquiring a correct knowledge of the disease, and to 
ascertain the best method of treatment. We think it will be 
admitted by most medical inquirers, that epidemic cholera, like 
other epidemics, varies in its nature, as it shall happen to be 
associated with peculiarities of location, of seasons, of modes of 
living, and many casual occurrences. It will follow, on this 
view, that, should the cholera continue to prevail, much time 
and observation will be necessary to fix, if, indeed, such a 
thing is possible, its true character; for it is truly of a protean 
nature. 

The disease of 1832 bore a good deal of similitude to yellow 
fever in its symptoms, but not at all in its general character. 
By measures well devised and well executed, our city was re- 
lieved of an appalling foe, with an expenditure of money very 
moderate in amount, and with a mortality which, under cir- 
cumstances present, leaves much room for thankfulness to 
Heaven for our having been relieved, after an amount of mor- 
tality far below what we had reason to apprehend, judging of 
what we had previously known of this destroyer of human life. 

In the month of February, 1832, the consulting physician 
for Baltimore addressed a communication to the Mayor and 
Board of Health, on the subject of cholera, in which he offered 
some facts and reflections in support of an epidemic constitu- 
tion of the atmosphere, which was about to control our diseases. 
February 19th, 1832, the consulting physician reported the 
following case to the authorities: 



104 EPIDEMIC CHOLERA. 

W. W. retired to bed at his usual hour, and awoke some time 
in the night suffering from severe cramps in the stomach, 
hands, and legs. Not wishing to disturb the family, he bore 
his sufferings ; and, after some hours continuance, those symp- 
toms subsided, and in the morning he felt well enough to rise 
and walk out. Remained pretty well during the day, and re- 
tired to bed without complaint; but early in the morning he 
was seized with sick stomach, to which was soon added diarrhoea 
and severe vomiting, all which harassed him for several hours ; 
by the mouth he ejected large quantities of greenish bile, and, 
per anum, considerable quantities of watery fluid, mixed with 
whitish mucus. The cramps continued severe in the stomach, 
hands and legs, and the fingers were painfully drawn in. We 
were absent, and did not see the patient for several hours, 
during which time he was under the care of another physician. 
We found him very much prostrated, skin very cool, face re- 
markably pale, pulse feeble and small, tongue slightly coated 
whitish. Severe pain in the region of the stomach, with spasms 
as often as he attempted to stir; purging and vomiting consi- 
derably abated, but the stomach still very sick. We prescribed 
as follows: B. Carb. Sodas 3j ; 01. Sassfr., gt. v; Tinct. Opii, 
gt. 1; Aq. pur. ^vj. Table-spoonful every hour, beginning a 
few minutes after taking the following: R. Submur. Hydr. 
9j., ft. pil. iij., one to be taken every hour. In the evening, 
three doses of the mixture have been taken and the pills, and 
he is comfortable. This patient was found convalescent next 
morning, having passed large quantities of bilious matter, 
brought away, no doubt, by the calomel. 

It was now and then rumored, by different physicians, during 
the winter, that they had seen cholera ; none were reported to 
the Board of Health ; during the winter, nothing further re- 
markable occurred, under our own notice, till the month of 
May, at which time disease of the stomach and bowels became 
common. On the 7th of June arrived the ship Brenda, from 
Liverpool, with one hundred and twenty-three passengers, of 
whom nineteen died on board; but the disease had entirely 
disappeared from the ship before her arrival. 

This arrival gave rise to great excitement at the Point (the 



CHOLERA IN BALTIMORE IN 1832. 105 

lower part of Baltimore), and placed the health officer in a very- 
unpleasant situation. A large portion of the people had formed 
their opinions, and many were disposed to pay no respect to 
the health officer or any one else, and the 7 most unreasonable 
and extravagant projects were proposed for warding off the 
supposed contagious cholera. The health officer was early 
convinced that there was no risk of importing cholera; but 
prudence, and, indeed, public safety, required that the prejudices 
of the people should be respected. No one could tell how soon 
the disease might make its appearance, and accidental coinci- 
dence, as to the arrival of shipping and the disease, might have 
led to wrong impressions, and in this way, for a time, the 
truth might have been obscured, and to many entirely con- 
cealed. Upon the whole, prudence dictated the propriety of 
conforming to the wishes of the people. Such were the mo- 
tives which influenced the consulting physician, although his 
mind was wholly made up as to non-contagion, and we know 
that such were the motives of the Board of Health in sustain- 
ing the health officer in his quarantine measures. There was, 
however, another reason for adopting every precaution to guard 
against the admission of passengers or shipping, under any cir- 
cumstances, without examination. Some of our sister cities were 
prepossessed with the belief of the importability of cholera ; it 
therefore became necessary, as well on account of the respect 
due our neighbors, as in self-defence, to adopt the same measures 
of defence as if we had been contagionists. We saw here that 
a refusal, on our part, might have shut us out from other ports. 
Hence it was, that the Baltimore Board of Health regularly 
and vigilantly enforced quarantine regulations against cholera, 
when the Mayor, Board of Health, Health Officer, and the 
Consulting Physician, were all non-contagionists. While some 
other cities were trusting to prohibitory measures in consider- 
able degree, we were engaged at an early period in improving 
the condition of the city by the removal of everything which 
might tend to contaminate the atmosphere. In these sanitary 
measures, our City Councils early showed a becoming zeal for 
the employment of preventive measures. 

The City Councils were convened by the Mayor (Col. Win. 



106 EPIDEMIC CHOLERA. 

Stewart) in the month of June,. and an ordinance was passed, 
and obtained the signature of the Mayor on the 26th of June. 

Section 1st provides that every person arriving from sea, or 
coastwise, from a foreign country, or any place where any con- 
tagious disease existed, should be detained at the quarantine 
ground, now removed to a distance not less than a mile below 
the fort. Section 2d provides that every vessel, of every de- 
scription, coming from any port within or without the United 
States, where any dangerous or contagious disease exists, 
and every vessel in which any contagious or dangerous disease 
existed, within thirty days of her arrival in the Patapsco River, 
shall remain at anchorage to be designated as aforesaid, at 
least fourteen days. Section 3d provides against vessels which, 
having sailed for other ports, afterwards altered their destina- 
tion, with intent to land at Baltimore. Under such circum- 
stances, they were compelled to ride quarantine at least thirty 
days ; and a discretionary power was given the health-officer 
to detain longer, if deemed necessary. 

Section 4th provides, that no person shall be brought into 
the city of Baltimore within fourteen days of their arrival from 
a foreign country. Sections oth and 6th provide severe penal- 
ties for violations of any of the foregoing ordinances. Section 
7th gives a discretionary power to the health-officer to permit 
persons to go on shore, provided ample security could be given 
that they would not remain within three miles of the city, nor 
come into it. 

"With a view to relieve all passengers, as far as circumstances 
would allow, from all unnecessary restraint or privation, a 
steamboat was procured for the purpose of relieving crowded 
vessels, and affording comfort to any that might be sick ; and 
another health officer was added to the Quarantine office. By 
these measures much was done to render the situation of per- 
sons detained as comfortable as the nature of the case would 
admit, and, no doubt, the health of the passengers was thereby 
essentially promoted. The value of these measures may be 
estimated when we inform our readers, that during six months 
that our quarantine existed at Baltimore, beginning with the 
first of May, 11,946 passengers arrived at quarantine, and 
there was not a solitary case of cholera of malignant or milder 



CHOLERA IN BALTIMORE IN 1832. 107 

aspect at the quarantine or among the shipping ; a fact which, 
while it speaks to the praise of the health officer, tends irre- 
sistibly to prove the non-contagious and non-migratory nature 
of the epidemic cholera of 1832 in Baltimore. 

On the 7th of July, the City Councils of Baltimore passed 
ordinances in anticipation of the cholera, which was seen to be 
coming towards that city. It was enacted and provided: 1st, 
That the usual number of superintendents of streets be doubled. 
2d, They were required to visit twice a week every street, lane, 
or alley, public or private, and have them scraped and swept, 
and filth or dirt to be immediately removed. 3d, Cellars and 
other places to be whitewashed wherever necessary. 4th, To 
visit, twice a week, all vacant lots, lumber-yards, brick-yards, 
tan-yards, slaughter-houses, manufactories, distilleries, cattle- 
yards and hog-pens, and see to their purification. 5th, All 
gutters to be examined and repaired, or the course of the 
water to be altered, should it be deemed necessary. 6th, Fire- 
plugs of the hydrants to be opened twice a week, and gutters 
well washed out. 7th, No stagnant water to be sprinkled on 
the streets. 8th, All vaults and privies to be examined and 
limed, should it be required to improve their condition. 9th, 
Street manure, when removed, to be limed where deposited. 
10th, Discretion given to the Board of Health to continue 
these regulations till 31st of October. 11th, Board of Health 
authorized to engage the Maryland Hospital, and make pre- 
paration for cholera patients by preparing bedding, &c, and 
also fit up as many houses within the city as may be thought 
necessary. 12th, Consulting physician and Board of Health 
directed to appoint physicians, to be stationed at the hospitals. 
13th, Authorized the Mayor to appoint an apothecary in each 
ward, where medicines could be had, at all hours, for sick of 
cholera, at the city expense. The above regulations were 
faithfully carried out, and all low or wet places, mouths of 
sewers, &c, well limed. These measures, it will be seen, com- 
menced early in July, but they did not prevent the occurrence 
of cholera early in the second week of August ; but no doubt 
four weeks, bestowed in the purification of the things within, 
must have improved the atmosphere of the city, and lessened 
both the extent and the mortality of the disease. 



108 EPIDEMIC CHOLERA. 

It will be seen, by reference to section 11th, that the Board 
of Health, with the approbation of the Mayor, had power 
given to them to rent or erect as many buildings as might, by 
them, be deemed necessary, and provision was also made for 
furnishing every building thus rented or erected, to be fitted 
up with the requisite bedding, &c, &c, and also appoint a 
physician for each place. It is easily seen what an enormous 
expense might thus have been incurred under an ordinance so 
liberal. 

The consulting physician, aware of the great expense which 
would attend the establishment of any considerable number of 
hospitals (twelve were designated), and aware, too, of the diffi- 
culty of locating these buildings to the wants or convenience of 
the poor, and believing that none but large, airy buildings were 
suitable for cholera hospitals, used his influence with the Mayor 
and Councils, to limit the hospitals to two, to which should be 
added a cholera dispensary, and one physician for each of the 
twelve wards should be appointed. Provision having been 
made by the City Councils for this purpose, on the 7th of July, 
the Mayor appointed the physicians accordingly, leaving the 
whole choice to the consulting physician. 

These physicians, who were all gentlemen of good experience, 
were appointed on the 13th of July, and held themselves in 
readiness to act when called on ; but their services did not 
begin till the second week of August. So far as we have been 
informed, the first case of malignant cholera occurred in Bal- 
timore, on the 4th of August, 1832. On that day, a little 
girl, about seven years of age, died suddenly ; but we were not 
aware, at the time, that she died of cholera. She was of re- 
spectable parentage, and in a neighborhood where cholera was 
not likely, from appearance, to show itself, being a very re- 
spectable neighborhood, and having clean and airy buildings ; 
but there were several deaths afterwards in the location desig- 
nated, which was at the corners of Liberty and Baltimore 
Streets. On the same day of the death above noticed, there 
died an old colored man, aged 84 years. This case, at the 
time, we believed to be cholera ; we saw him a few hours before 
his death. One of our most respectable physicians insisted 



CHOLERA IN BALTIMORE IN 1S32. 109 

that this was a case of common cholera morbus. A few days 
after this death, we were requested by Dr. Roberts to see a 
white boy affected with some peculiarity of symptoms, having 
severe vomiting and purging. He had eaten to excess of green 
corn and other vegetables the day before we saw him. The 
attack was in the night, and the doctor did not see him till 
morning, when he was greatly prostrated. We saw him in the 
forenoon, and found him greatly prostrated ; he was cold, and 
almost pulseless, the skin shrivelled, and there was a singular 
haggard appearance in the face — a strange blending of the 
features of youth and the contractions of old age. Death 
closed the scene. 

On the 9th of August, the Mayor called a meeting of the 
physicians of the city, which was well attended. Nothing of 
much importance grew out of the meeting. It was found that 
but few of the physicians had seen any cases having the aspect 
of cholera in its intense stage ; diarrhoea was common. Seve- 
ral of the physicians present were decidedly opposed to any 
acknowledgment of anything like a cholera epidemic in the 
city. Indeed, an attempt was made to pass a resolution, de- 
claring that cholera did not exist in our city. This measure 
was opposed by the consulting physician, who assured his 
brethren that he had seen cases of cholera at hospital No. 1. 
The first patient died. He asserted that this case presented 
symptoms which he had never seen in a practice of upwards of 
thirty years. He urged that he had seen cases whose aspect 
was new to him, and preceded as they were by, and associated 
with cholerine, prevailing in the city, there could no longer be 
any hope of escaping the epidemic, which was then making in- 
roads through our country. The meeting, by a small majority, 
decided that the cholera did exist to some extent in the city. 

On the 13th of August, twelve deaths from cholera were 
reported by the Board of Health. On the 20th, fifty-five cases 
had occurred. August 10th, the Mayor appointed, agreeably 
to an ordinance previously enacted, an apothecary in each ward, 
by whom medicine was to be furnished to the ward physicians, 
and these physicians were now set to business. They did their 
duty well ; but vigilance and zealous devotion to the sick was 



110 EPIDEMIC CHOLERA. 

not confined to the appointees, but many of our physicians of 
the city deserved the praise and thanks of the citizens, for 
their philanthropic devotion to the sufferings of the poor. We 
had nearly one hundred physicians in Baltimore, and although 
a few had the disease, but one of them died — what a stumbling- 
block to contagionists ! 

It was the duty of the ward physicians to attend all those 
who were unable to pay physicians, or unwilling to go to an 
hospital. A very large class of people, in time of an epidemic, 
become more or less panic-struck ; a great many came under 
this dispensary rule, and, no doubt, very many lives were thus 
saved. Many of the decent poor were not willing to be re- 
moved, and many would rather have perished at home, than 
leave it to go to an hospital. And, indeed, a very great number 
of cases occurred where life would have been lost by the delay 
of going to an hospital, to say nothing of the fatigue of removal. 
In a word, this dispensary establishment was eminently bene- 
ficial to the sick, and in view of expense, the saving was im- 
mense. 

There died of epidemic cholera in Baltimore, in 1832, 853 
persons (out of a population of 160,000). A very great majority 
of those who died were of the most worthless ; but a few of 
our respectable citizens fell victims to this scourge of humanity. 

A very great majority of the police officers, our merchants 
and citizens generally, early espoused the belief of cholera 
being an epidemic, not communicable by contagion ; such a 
conviction prevailing very generally, led to important conse- 
quences ; since, instead of relying on prohibitory laws or 
measures, they turned their attention to measures for purifica- 
tion of the atmosphere ; and this, some weeks in anticipation 
of what they knew would come. The consulting physician 
used every exertion to impress this upon the public. 

It may not be unimportant to inform our readers, that our 
measures were not more remarkable for their efficiency, than 
they were for the economy with which they were conducted on 
an extensive scale, to a happy termination. The City Councils 
provided a fund of forty thousand dollars. This was in part 
expended on permanent improvements ; fourteen thousand 



CHOLERA IN BALTIMORE IN 1832. Ill 

dollars were expended in repairing gutters, &c. ; the balance 
was found sufficient for all our measures of purification, and 
the most ample provision for the sick poor. When we look to 
our sister cities, and compare expenditures for cholera, and see 
the relief that was carried to every poor man's house, we may 
feel proud that our plans, which were novel, had answered so 
well. New York expended upwards of two hundred thousand 
dollars, and Philadelphia one hundred thousand dollars, for 
cholera purposes in 1832. 



BOARDS OF HEALTH OF BALTIMORE AND SAVANNAH. 

The Board of Health of Savannah having addressed the 
Board of Health of Baltimore, requesting such information as 
they might be able to give, respecting cholera ; and the con- 
sulting physician of Baltimore being very extensively engaged, 
the matter was referred to Dr. Carrere, under the supervision 
of the former. The Board of Health of Baltimore say : " The 
enclosed statement, made by Dr. Carrere, at Hospital No. 2, 
may be relied on as strictly correct ; the treatment has been 
in practice to considerable extent, and has been found very 
successful. The Board have the satisfaction to inform you, 
that the cholera is abating in our city, and we have good reason 
to believe, that if the citizens could be prevailed on to refrain 
from the use of fruits and vegetables of every description, 
either raw or cooked, the disease would in a few days dis- 
appear. 

" By order, 

" David Harris, 

"September 25, 1832." "Secretary. 

Letter of Br. Carrere. — " The disease I am disposed to believe 
to be of a bilious nature, of an aggravated form. Those labor- 
ing under it, have generally had some affection of the bowels 
(either in the form of diarrhoea or dysentery), for one or more 
days prior to the rice-water discharges by the mouth or stool. 



112 EPIDEMIC CHOLERA. 

When taken, the patients generally complain of an oppression 
at the proecordia, spasms of the stomach, arms and legs, pain 
in the head and back ; tongue furred white or yellow ; no urine 
after the attack ; pulse full and tense. In such cases I have 
derived the greatest benefit from the free use of the lancet, 
until the spasms and pain in the head and back are relieved, 
aild until there is a change in the color of the blood, which is 
at first of a very black color ; then commence with calomel 
and opium, in doses of ten to twenty grains of the former with 
one-half to three grains of the latter, for the first dose ; then 
calomel five grains, nit. pot. grains ten every half hour, till 
there are bilious discharges ; this to be assisted by castor oil, 
senna, manna, salts, rhubarb, aloes, &c. Should there be torpor 
of the bowels, which sometimes happens, scammony, gamboge, 
or croton oil have been serviceable. In cases of the yellow 
coating on the tongue, I have been obliged to use the aloes for 
a much longer time than usual. The nitrate of potass I have 
generally found to produce the secretion of urine in a day or 
two. 

In the collapsed stage, we have the rice-water discharges 
very profuse ; pulse feeble, and in some cases barely perceptible ; 
in others absent ; spasms of the stomach, arms, and legs ; 
tongue cold as ice ; oppression at the prsecordia ; extremities 
cold, and bathed in cold clammy sweat ; great thirst and sense 
of heat, when the whole surface, to the physician, is as cold 
as ice ; they are constantly asking for cold water, even until a 
few minutes before death : when it has been given to them, it 
invariably produces great restlessness. 

In such cases we commence with calomel and opium for the 
first dose ; then calomel and nitre were continued as in the 
first stage. Where ptyalism took place, I have generally found 
the patient to recover. In cases where they were bathed in 
cold clammy sweats, I have derived the greatest benefit from 
the use of warm lard, well rubbed in, on the arms and legs ; 
and repeated as often as it is absorbed, or the perspiration re- 
turns, always previously drying the parts well with a towel or 
piece of flannel. To allay the irritability of the stomach, I 
have made use of the following : R Carb. Soda 3j ; 01. Sassafr. 






BOARDS OF HEALTH OF BALTIMORE AND SAVANNAH. 113 

gtt. v., tinct. opii gtt. lxx., aqua pur. 3vj. Table spoonful to be 
given every half hour, hour, or two hours, according to cir- 
cumstances ; to be assisted by the effervescing mixture ; sina- 
pisms and epispastics. For the suggestion of the lard, I am 
indebted to the consulting physician, Dr. H. G. Jameson. 
Dry heat has been applied to the extremities ; but I cannot 
say much in favor of it, owing to the great restlessness of the 
patients. Tonics and stimulants have been tried, but were not 
found useful, and have been laid aside for upwards of a month. 
During convalescence great care should be paid to diet. Three 
patients who were doing very well for five days, to each of 
whom a very small piece of bread was given, relapsed in a few 
hours after eating it and died." 

" Post-mortem Examinations. — In general, I have found 
the brain very much injected, especially in persons of intem- 
perate habits ; the lungs were generally found flaccid, nearly 
natural in color; the heart; generally speaking, bloodless ; when 
any was found, it was of a very black color, and viscid ; the 
liver pale, and little or no blood in it ; the gall-bladder gene- 
rally distended with viscid bile ; the stomach very much con- 
gested, and presented blotches, sometimes dark ; generally 
reddened by injection of the inner coat; the speen bloodless; 
the intestines very much congested, especially the ileum, which 
was reddened ; the kidneys very flaccid ; no urine, or urinous 
smell; bladder contracted to the size of a walnut." 

Br. Mackenzie, at Hospital No. 1, furnishes us with the 
following list of periods at which death took place, after the 
admission of patients : — Three died in 15 minutes ; three in 20 
minutes ; one in 30 minutes ; one in 40 minutes ; three died in 
about an hour ; three in 2 hours ; one in 3 hours ; one in 4 
hours ; two in 5 hours ; three in 7 hours ; two in 8 hours; two 
in 9 hours; two in 11 hours; one in 14 hours; one in 15 
hours; one in 16 hours ; three in 18 hours ; eleven died in 2 
days ; four in 3 days ; six in 4 days ; four in 5 days ; two in 
6 days ; three in 7 days ; two in 9 days ; one in 11 days ; one 
in 12 days ; one in 18 days. Admitted 147, died 68, cured 79. 

Br. Carrere, Hospital No. 2, reports that two died in five 
minutes after admission ; one in 30 minutes ; two in 1 hour ; 



114 EPIDEMIC CHOLERA. 

four in 2 hours ; four in 3 hours ; five in 4 hours ; four in 5 
hours ; three in 6 hours ; two in 7 hours ; four in 8 hours ; 
two in 9 hours; three in 10 hours ; four in 13 hours; two in 
14 hours ; one in 15 hours ; seven in 1 day ; two in 2 days ; 
two in 3 days ; two in 4 days ; three in 5 days ; two in 7 days ; 
one in 11 days; two in 12 days; one in 16 days. Total 145, 
died 65, cured 80. Grand total in three hospitals, 386. Num- 
ber greatly lessened by the dispensary. 

We deem it proper to give an abstract of the streets, lanes, 
and alleys, from which the patients were brought to the cholera 
hospitals ; by this abstract it appears that patients were brought 
from upwards of eighty different places, and the greatest num- 
ber from any one street was fourteen from High Street. These 
admissions run through a period of fifty days ; many of them 
from quite retired places, remote from any free communica- 
tion ; and, except what was done at the quarantine, everything 
about our municipal regulations and hospitals, was done under 
the belief of non-contagion, nor was there one case that might 
serve to invalidate that opinion. 



HOSPITAL PRACTICE IN THE EPIDEMIC CHOLERA OF 1832. 

The practice, which gradually settled down to a good share 
of uniformity, and, we think, will compare favorably with any- 
thing which has been employed up to the present time, will 
be best illustrated by a diary of cases, and their treatment, 
through a couple of pages. The reader will not lose sight of 
the character of the patients that were inmates of our hospi- 
tals; many of them were moribund when brought in, or the 
disease far advanced, and a great majority were persons of in- 
temperate habits. The following diary was kept by Dr. Car- 
rere, who was stationed at Hospital No. 2. 

Aug. 10th, 1832. Betty Buckler, get. forty (Charles and 
Lombard Streets). When she entered the hospital she was in- 
toxicated. Blood had been taken, and a mustard plaster ap- 
plied to the epigastrium ; pain in the head and stomach, and 



HOSPITAL PRACTICE IN THE EPIDEMIC OF 1832. 115 

sickness at the stomach ; tongue slightly furred ; bowels con- 
stipated; took the following: R. Sub. Carb. Sodse, 5j« > 01. 
Sassafr. gtt. v. ; Tinct. Opii, gtt. lxx. ; Aqua, ^vj. Table-spoon- 
ful every hour. Towards evening, pain in the head and 
stomach, and sickness much relieved. R. Subm. Hydr., gr. 
x. at bed-time. 11th. Rested during the night; pains and 
sickness have nearly left her ; the medicine having operated, 
she was much relieved. 14th. Complains of headache ; tongue 
furred. R. Calomel and aloes, ten and ten. 15th. Tongue 
furred ; bowels not well opened. Calomel and aloes ; bowels 
opened ; stools bilious ; feels better. 16th. Feels much better; 
took nourishment. R. 3j. tinct. gentian., three times a day. 
17th. Convalescent. 

August 10th. Aaron , aet. thirty. Mustard had been 

applied to the wrists, thighs, and epigastrium. Tongue moist ; 
extremities cold ; voice husky ; had been eating a quantity of 
water-melon ; skin on the hands shrivelled ; in articulo mortis 
when brought in ; saline injections ; the temporal artery was 
opened, and a pint of blood was obtained. He came in about 
eleven o'clock, and died about two. We shall defer our re- 
marks on the saline injections, and also the dissection of this 
subject, till we come to their appropriate places. 

Aug. 10th. Mr. Cooper. Stomach irritable, vomits occa- 
sionally ; purging two days ; evacuations bilious ; tongue furred. 
At two o'clock, took Subm. Hydr. 9j. ; sinapisms applied to the 
epigastrium ; vomiting has ceased ; continue mixture, saline. 
R. 01. Ricini, gij., also calomel and aloes. 12th. Stomach 
very irritable ; sinapisms applied to the epigastrium ; effer- 
vescing mixture, which quieted the stomach, and he took and 
retained some chicken-water. 13th. Better in every respect. 
Tinct. Gentian., 5j., every three hours, with some brandy. 15th. 
Discharged convalescent. 

Aug. 11th. Saml. Cheers, set. thirty-two, has been unwell a 
day or two with vomiting and purging ; what was thrown up 
was similar to rice-water, that passed by stool, curdled ; cramps 
of stomach and extremities. Saline mixture (already noticed, 
of Carb. Sodae, 01. Sassafras, and Tinct. Opii, &c.) Sina- 
pisms applied to the epigastrium and extremities. R. Camph., 



116 EPIDEMIC CHOLERA. 

gr. ij. ; Calomel, gr. xx. At two o'clock, an injection was ad- 
ministered, but to no purpose. Half-past two o'clock, one 
drop croton oil and one-fourth grain opium ; took two doses. 
A tobacco injection was then given ; relieved the spasms in the 
stomach ; produced a slight acceleration in the pulse and vomit- 
ing. R. Camph., Carb. Ammonia, aa, gr. v., to be given every 
hour, with brandy every half hour. Died at five o'clock. 
Post-mortem examination will be given in place. 

Aug. 12. Matilda Jackson, set. 19, had been lying out of 
doors for thirty-six hours ; when brought in, was in a state of 
collapse ; pulse small ; tongue cold ; vomiting and purging 
similar to rice-water. R. Saline Mixture; R. Subm. Hydr., 
Camph. Carb. Ammonia, aa, gr. v., to be taken every hour ; 
brandy and water every half hour ; sinapisms to the epigas- 
trium and legs; pulseless from five o'clock in the evening. 
13th. Pulseless; powders continued every three hours; about 
two o'clock, afternoon, excitement began to take place ; 
tongue warm; stomach somewhat affected; nine o'clock, pulse 
better ; surface warm. 14th. Powders continued every three 
hours ; brandy every quarter hour ; effervescing mixture to 
allay the irritability of the stomach; evening not so well; 
bowels not opened. R. 01. Ricini, 01. Terebinth, ana Jij., 
every hour; mixture continued; brandy and water as usual. 

15th. Appeared better. R. 01 Ricini, 01. Terebinth, aa 3ij«> 
continued; towards seven o'clock became delirious, and died 
quarter past nine o'clock. The dissection will be given in 
place. 

Aug. 12th. Samuel Branson, set. forty; sickness at stomach; 
bowels affected some days; discharges watery; had been eating 
water-melon the day he was taken. R. Calomel and aloes ; 
sinapisms to the epigastrium ; bowels acted on several times ; 
faeces extremely offensive. Saline mixture and R. Calom., gr. 
ij. ; Jalap, gr. ij. ; Nit. Pot. gr. v., one to be given every hour. 
14th. Rather better ; stools less offensive. Cal. and aloes in 
the evening. 15th. Better; R. Cal., gr. x. 16th. Bowels 
well opened ; mouth very sore. From this time he convalesced, 
and was discharged well in a few days. 

Aug. 14th. Richard Lee, eat cucumbers last night; purging 



REMARKS ON CASES IN BALTIMORE HOSPITALS. 117 

and cramps this morning; rice-water discharges; tongue furred. 
Sinapisms to the epigastrium, and an emetic, before coming in. 
B. Subm. Hydr. gr. x., every hour till the bowels be opened; 
saturated solution of Mur. Sodse; saline mixture. 15th. Rested 
well last night ; repeat Submur. Hydr. ; bowels opened ; stools 
bilious. 16th. Convalescent ; bowels opened. 18th. Relapsed 
this morning; tongue and surface throughout cold; clammy 
sweat ; pulse very feeble ; had been eating some bread yester- 
day, to which was ascribed the relapse ; died on the morning of 
the 19th. Dissection will be given in place. 

Owing to the hurry and confusion attendant on an appalling 
disease, while filling an hospital with patients, and a number of 
physicians, from a distance, calling daily for the purpose of 
obtaining information of the disease, and there being but one 
house physician, the foregoing report of cases is less satisfac- 
tory than we could wish ; nevertheless, we feel fully satisfied that 
the result of the treatment employed is, under equal circum- 
stances as to the vicious kind of patients we had to deal with, 
as favorable as could be expected; this, indeed, was much ag- 
gravated by our having a cholera dispensary in operation, 
which kept away the better patients : all those that may be 
termed the decent poor, were provided for in their own houses, 
and in this last accommodation the success was more satis- 
factory. 



ANOMALIES, WITH REMARKS ON SOME OF THE CASES WHICH 
WERE UNDER TREATMENT IN THE CHOLERA HOSPITALS IN 
1832 IN BALTIMORE. 

Such had been the unsettled state of things, as regards the 
nature of epidemic cholera and its treatment, when the disease 
appeared in Baltimore, that a good deal of variety occurred in 
the choice of remedial agents ; but after the trial of such as 
seemed to have acquired some comparative celebrity, we settled 
down to a pretty regular method of treatment, which, we still 
believe, was well suited to the disease as it was then charac- 
terized. 



118 EPIDEMIC CHOLERA. 

Among the pathognomonic symptoms, rice-water discharges 
were most common, either at the time of admission, or had 
preceded, to more or less extent, cold tongue and surface, in- 
difference to danger, paucity of urine ; but sixteen cases were 
noted presenting bilious discharges, out of one hundred and 
seventeen that were reported from Hospital No. 2. Then, we 
may note that seven cases were attended with constipation at 
the time of admission; these required active cathartic medicines, 
such as calomel and aloes, scammony once, senna and salts 
frequently, croton oil three times, tobacco injection once, for 
opening bowels and for spasms of the stomach. Dark stools 
are noted three times. One case was attended with ileus, and 
was fatal. 

Temporal artery opened once ; pint of blood drawn ; case 
fatal. The stools are noted as being yellow five times ; bilious 
vomiting four times ; saline emetic four times ; slimy passages 
twice, once red ; tongue red six times ; coma twice ; mania-a- 
potu once ; two cases of parturition — one died, one recovered ; 
tongue dark, typhous-like, once. Seven cases had symptoms of 
dysentery. Chills were uncommon ; but we had seven cases 
noted; tongue purple twice. Cough noted once. Urticaria of 
face, breast, and arms, once, and fatal. Vertigo once, and re- 
covered. Convulsions twice, fatal ; inflammation of the eye, 
one. Husky voice noticed three times. Stools noted as being 
once very offensive. 

The following medicinal articles were tried : Turpentine and 
castor oil four times; laudanum and kino twice; lead and opium 
once ; venesection sixteen times, some before coming in ; tinct. 
cantharides used eight times. Cups were applied once to the 
epigastrium, but no blood could be obtained. Turpentine in- 
jection once ; quinia seven times ; sublimate, in ointment to the 
epigastrium, once ; this article will blister in less than an hour ; 
case fatal. We had five relapses after complete convalescence. 
Actual cautery to spine once, of no avail. Epispas. to epigas- 
trium once. One patient had spasms of the occipito-frontalis 
muscle. Two subjects had spasms of the thighs and other 
parts after death ; one case for more than one hour. 

Dr. Carrere has remarked that the pulse was sometimes full 



HOSPITAL NO. 3, IN BALTIMORE,, IN 1832. 119 

and tense, and, in such cases, free bleeding was found very 
useful, and, when resorted to, the blood was allowed to flow 
till spasms ceased and the blood appeared redder. He says 
the mercurial sore mouth was generally followed by recovery. 
It may suffice, on this part of our subject, to say, that our 
practice settled down to the use of calomel and nitrate pot. as 
a standard remedy, and the alkaline solution (of carb. sodae, 
tinct. opii, and ol. sassafr.) ; and in the early stage of spasmodic 
symptoms, or free alvine discharges, the free use of opium, 
calomel, and castor oil, were valuable remedies. We must not 
overlook Dr. Carrere's remark respecting the use of melted 
lard for the purpose of restoring warmth to the skin, and 
checking clammy cold perspiration, upon which little impres- 
sion could be made by dry heat, owing in part to the great 
restlessness of patients; and he says, "Tonics and diffusible 
stimulants were tried, but were not found useful, and have been 
laid aside upwards of a month." The same remark applies with 
equal force to Hospital No. 1, under the care of Dr. George 
Mackenzie. We shall hereafter refer to some of Dr. Macken- 
zie's cases. 



HOSPITAL NO. 3, IN 1832, IN BALTIMORE. 

The Mayor and Board of Health thought proper to open a 
third nospital for cholera patients in the epidemic of 1832. 
Dr. Augustus L. Warner was appointed to the care of this es- 
tablishment. The Doctor having, long since, paid the debt of 
nature, we are disposed to notice the remarkable discrepancies 
between his reports and those of No. 1 and No. 2 with all 
possible respect and forbearance ; but the medical profession of 
Baltimore being aware of Dr. Warner's engagement at one of 
our cholera hospitals, it will be expected that we notice his 
reports in this work, with those of No. 1 and No. 2. Besides, 
we have given publicity to the reports for Hospital No. 3 in 
one of the volumes of a medical journal which we were publish- 
ing at the time the cholera epidemic prevailed in Baltimore, 
and it might appear strange that we should not notice the re- 



120 EPIDEMIC CHOLERA. 

ports of No. 3, the more so from the several remarkable dis- 
crepancies which we have already named, and which we now 
proceed to examine. 

" The progress of cholerica epidemica may be divided into 
different stages or conditions — the premonitory diarrhoea, the 
rice-water evacuations from the stomach and bowels ; the cold, 
blue, collapsed, or asphyxiate states; the typhoid fever." Our 
experience leads us to remark, that while epidemic cholera is 
strongly characterized by a few unmistakable pathognomonic 
symptoms, it may truly be said to be a protean disease, whe- 
ther we look at its coming and going, its mode of invasion of 
the human system, the result of remediate agents, &c. And 
such is the extent of these irregularities, that all attempts at 
classification of its symptoms are altogether futile ; of this w r e 
shall have occasion to say more, under the head of specialities. 
Agreeably to Dr. Warner's attempted " stages or conditions," 
he has reported many cases as being admitted into the hospital 
"verging into collapse" — "first stage of the disease" — "second 
stage of the cholera" — "fourth stage, or typhoid fever" — 
"diarrhoea;" frequently "first stage of collapse." It is re- 
markable that our author has reported a considerable number 
of cases as being in such or such a stage, and founded his 
treatment on that ground, and yet has not noted one case as 
being in the "third stage." These stages being in good degree 
gratuitous or undefinable, we cannot determine the amount of 
danger attached to his cases. He reports fifteen out of ninety- 
six as his fatal cases. 

" Having honestly and faithfully tested the various modes 
of treatment recommended in this disease, I have no hesitation 
in stating the following as the result of my experience, after 
frequent repetition. The indiscriminate use of the lancet is 
highly injurious, and in a vast majority of cases injudicious or 
unnecessary. The preparations of camphor I am disposed to 
consider inert and inutile. Calomel and opium decidedly 
prejudicial. The tincture guaiac. was freely used, and in no 
instance with benefit, while the most melancholy consequences 
attended its administration." One might wonder where the 
Doctor could have acquired his experience in respect to an in- 



HOSPITAL NO. 3, IN BALTIMOKE, IN 1832. 121 

discriminate use of the lancet. Verily, verily, a physician who 
could employ bloodletting to the extent here noted, would, in- 
deed, require schooling ; but by reference to the reports of our 
hospitals, No. 1 and No. 2, which we shall elsewhere notice, 
and, also, in our specialities, we shall see that bleeding, well- 
timed and well-suited, is a remedy of much importance. 

We are told that "camphor is inert or inutile." Camphor 
is not to be relied on as a main remedy in any stage of cholera, 
but it may be used, when on hand, as a carminative for painful 
flatulency, or sickness at stomach, but probably is no better 
than peppermint, mint-tea, ginger, or pepper-teas, &c. " Ca- 
lomel and opium decidedly prejudicial." Here we must ex- 
press some surprise. It will be seen by reference to the treat- 
ment of cholera in Hospitals No. 1 and No. 2, that these 
remedies were relied on as principal remedial articles, and with 
a success which brought the decided approbation of the Board 
of Health, and many of the most respectable physicians of 
the city. In the present disease, it was almost as necessary to 
know what was inert or hurtful, as what was more successful, 
seeing that the disease was new, whether we speak of its mere 
existence, or of the great diversity of remedies which had been 
and still were in use. 

The author before us makes a "typhoid stage, or fourth 
stage of the epidemic cholera." We apprehend that if there 
is any just ground for such a stage, that it will obtain princi- 
pally with patients who are treated on too stimulant a plan. 
We have seen a good deal of cholera, and can truly aver that 
we have not seen five cases showing the character of typhoid 
fever. In the earlier stages of the disease, it will yield to 
suitable treatment ; and, if advanced to the condition of col- 
lapse, the patients nearly all die under any treatment that has 
yet been employed; but we have no doubt, from what we have 
seen in other diseases, that by too much stimulation, a sort of 
pseudo-typhoid condition will occur, where the energies of the 
patient carried him through the collapse ; but even in such cir- 
cumstances we shall have rather a sequela of the disease, than 
a real stage of typhoid cholerica proper. 

" It has been said that the third or collapsed state is wholly 



122 EPIDEMIC CHOLERA. 

incurable — that the physician must stand by, an inactive spec- 
tator of the ravages of the disease ; but I have strong reason 
to presume that experience and observation have shown, that by 
the well-directed efforts of the physician, the unrelenting tyrant 
may be hurled from his throne, and his victim snatched from 
an untimely and impending fate. The following treatment has 
not as yet failed in one case in which it was adopted : 
B. Tinct. Assafoet. 3iij-> followed in 5j. doses every half 
hour, accompanied by the hourly exhibition of the following 
powder : B. Pulv. Rhei, gr. x. ; Nit. Pot. gr. v. ; Pulv. Scillse, 
gr. ss. ; Sulph. Quinia, gr. iij., assisted by the liberal use of 
warm toddy and chicken-water. Should the stomach be irri- 
table, and reject the above medicine, administer P. Ipecacuan. 
5j., followed by free draughts of warm water. After the 
emetic has operated freely, renew the medicine [we suppose 
not the ipecacuan], R. Empl. Vesicat. to the abdomen." 

We write not to find fault, but hoping to benefit mankind ; 
and what shall we say here of a discovery so momentous as a 
means of curing cholera in the " third or collapsed stage." It 
was our duty to visit, officially, all the hospitals every day ; 
this we did faithfully at No. 1 and No. 2, during the epidemic, 
but at No. 3 we called occasionally only, because, although its 
house physician treated us with marked respect, he always 
manifested a reluctance to speak of his mode of treatment ; 
nor did we there hear anything of the discovery of the great 
value of the fetid tincture. Need we desire the reader to 
compare the declaration of a sovereign cure for the " third 
state" with the result of all other modes, plans, or devisements 
in all other hospitals, and in all places ? We do not recollect 
that we have seen the use of the fetid tincture as a chief 
remedy, which it seems to have been here. We give the em- 
ployment of it to the reader for what it is worth, not having 
tested it in our practice. We had charge of all the cholera 
hospitals in 1832, as principal physician, and had we been ap- 
prised of such invaluable therapeutic properties of assafcetida, 
it would have been as much our duty to adopt it as it was the 
duty of the incumbent of No. 3 to communicate his good for- 
tune to the chief physician of the cholera hospitals. 



HOSPITAL NO. 3, IN BALTIMORE, IN 1832. 123 

" The great liability to mercurial impression at this time is 
a matter of common observation, and the slightest reflection 
would suggest the ill effects of mercurial ptjalism upon the 
nervous system, already excited and irritated to its highest 
point. Independent of this, the depressing effects of large 
doses of calomel have oftentimes rendered hopeless the con- 
dition of him whose constitution and mode of life proffered a 
strong assurance of speedy relief." We might ask here, where 
did our author get his knowledge of these baneful effects of 
calomel ? not at No. 1 and No. 2 ; and we do not see, in his 
reports, that calomel had been much used in Hospital No. 3. 

Let us here turn for a moment to Dr. Carrere's letter to the 
Board of Health of Savannah. He says : " In the collapsed 
stage, we have the rice-water discharges very profuse, pulse 
feeble, and, in some cases, hardly perceptible, in others absent ; 
spasms of the stomach, arms, and legs ; tongue cool, or cold as 
ice ; oppression at the prsecordia ; extremities cold, and bathed 
in cold, clammy sweat ; great thirst, and sense of heat, when 
the whole surface is to the touch as cold as ice — they are con- 
stantly asking for cold water, even until a few minutes before 
death. When it has been given to them, it has invariably pro- 
duced great restlessness." " In such cases we commenced, for 
the first dose, with calomel and opium ; then the calomel and 
nitre were continued, as in the first stage ; where ptyalism has 
taken place, I have generally found the patients to recover, 1 ' 
Calomel was given by Dr. Carrere through the epidemic, in 
doses from two to ten grains, in all stages of the disease, and 
we shall presently show that Dr. Mackenzie used it rather more 
freely than his co-laborer in the hospitals, and the result of 
their labors was not behind that of any institution in this or 
any other country, as far as we know. 

Dr. Warner complains that many of his patients were 
treated by other physicians before coming in, and alleges this 
as one of the causes of mortality. So far as this may argue a 
delay or advance of the case, the position he takes is legiti- 
mate ; but viewing this matter in extenso, we must admit, that 
the success is pretty much the same, under the treatment of 
all regular physicians. Be this as it may, the same state of 



124 EPIDEMIC CHOLERA. 

things obtained at No. 1 and No. 2. We have already inti- 
mated, that we were instrumental in getting up a cholera dis- 
pensary in the cholera of 1832 ; this provided for all who had 
anything like a decent or comfortable home ; then, besides the 
twelve public jihysicians, the physicians generally, as is usual 
with the profession in times of panic or severe epidemics, were, 
with the appointees, found foremost in works of humanity, and 
were constantly administering to the sick poor, and their good 
works were facilitated and extended by the city having provided 
apothecary shops, where every physician could have his pre- 
scriptions supplied to those who required such helps ; hence it 
was, that almost none but those who were homeless or comfort- 
less at home as to particularly require removal to an hospital, 
came in. Setting apart the vicious individuals, this tended 
strongly to bring cases which, despite of all skill and care, 
would greatly increase the proportional mortality. 

It has been asserted by Dr. Warner, that it has been said, 
in the third or collapsed stage, " the physician must stand by, 
an inactive spectator of the ravages of disease." We have 
not had the opportunity of seeing, or even hearing of such a 
procedure ; but, on the contrary, we have seen, in all times 
and places where cholera existed, such a diversity of medica- 
menta for the cure of the malady, as has never occurred in any 
other disease ; — such a ransacking of the Materia Medica, allo- 
pathic and homoeopathic, was never seen before; then the para- 
phernalia of the kitchen, — salt, pepper, ginger, fire, ice, &c, — 
come in for a share of the curative means for cholera, without 
special regard to different stages ; and it is to be feared that this 
widely-extended array of medicamenta was less harmless some- 
times than "the stand by of an inactive spectator." 

CHOLERA TREATED ON AN ANTIPHLOGISTIC PLAN. 

Thursday, Sept. 20th. James Flemming, ast. twenty-nine, 
admitted at half-past two, p. m. Intemperate ; arrived from 
Philadelphia yesterday; has had diarrhoea for ten days; taken 
with vomiting and purging (rice-water); severe cramps; great 
thirst; tongue brown; surface warm ; pulse full ; passes urine. 



CHOLERA TREATED ON AN ANTIPHLOGISTIC PLAN. 125 

Treatment. — Venesect., calomel and opium; calomel and nitre, 
saline mixture ; frictions with lard; calomel and aloes, infusion 
of senna, sinapisms. Recovered. 

Saturday, 22d. Edward Weaver, set. thirteen ; has been eat- 
ing nothing but fruit, and lying out in the open air for three or 
four days past ; collapsed ; died eight hours after admission. 

John M'Cready, set. fifty. A few days from Philadelphia : 
has had diarrhoea for several days; was on a frolic last night; 
when admitted he had frequent watery evacuations; tongue 
white; pain in the stomach; surface warm; pulse full; passes 
urine. Treatment. — Venesect., calomel and opium, cal. and 
nitre, saline mixture, ol. ricini. Recovered. 

Sept. 23d. Henry Drofter, set. thirty-two. Intemperate ; was 
taken last evening with vomiting and purging; when admitted 
he had no vomiting, but frequent light-brown evacuations, 
mixed with a very bright-yellow fluid; severe cramps; great 
thirst ; tongue white ; pulse full ; surface covered with sweat ; 
passes urine freely. Treatment. — Venesect., calomel and 
opium, frictions with melted lard, calomel and nitre, saline 
mixture, ol. ricini, sinapisms. Recovered. 

Sept. 24th. Francis M'Coy, set. nineteen ; sickened this morn- 
ing ; has had diarrhoea for two days ; lay for some time yester- 
day on the damp ground ; was taken at two o'clock this morn- 
ing; was seen by Dr. Yates, who gave him some medicine ; has 
now no vomiting, but frequent watery evacuations ; pain in the 
stomach; pulse feeble; tongue white; surface cold and covered 
with sweat ; passed no urine since yesterday. Treatment. — 
Calomel and opium, cal. and nitre, saline mixture, frictions 
with melted lard, ol. ricini, sinapisms. Recovered. 

Sept. 24th. Gregory, set. thirty-six ; sickened this morning ; 
has been bled ; w T hen admitted, frequent purging ; pain in the 
stomach ; tongue white ; pulse soft ; surface warm. Treatment. — 
Calomel and opium, cal. and nitre, saline mixture, calomel and 
aloes, sinapisms. Recovered. 

Sept. 24th. Hester Dorsey, set. thirty-eight ; has had diar- 
rhoea several days ; was taken yesterday morning with vomit- 
ing and purging ; severe cramps ; has been taking Thomsonian 
medicine ; collapsed. Result omitted, — suppose she died. 



126 EPIDEMIC CHOLERA. 

Sept. 25th. Ann Thomas, set. forty-five; taken -with vomit- 
ing and purging ; has had no medicine ; when admitted, no 
vomiting, but frequent purging ; severe cramps ; tongue brown ; 
full pulse ; surface warm ; passes urine. Treatment. — Vene- 
sect., calomel and opium, cal. and nitre, saline mixture, fric- 
tions with lard. Recovered. 

Sept. 25th. Priscilla Jones, set. forty-seven. Has been sick 
for some time ; has been eating fruit ; taken two or three days 
since with vomiting and purging ; when admitted, no vomiting, 
but frequent watery passages ; severe cramps ; tongue brown ; 
pulse very feeble ; surface cold and covered with sweat ; pain 
in the stomach ; has passed no urine for two days. Treatment. 
— Calomel and opium, cal. and nitre, frictions with melted 
lard, saline mixture, sinapisms, &c. Died. 

Sept. 25th. James Dyer, set. thirty-six. Has been sick seve- 
ral weeks; taken day before yesterday with vomiting and 
purging ; ate apples ; vomiting and purging when admitted 
(rice-water) ; cramps of the legs and arms ; tongue brown ; sur- 
face cold ; pulse very feeble ; passes no urine. Treatment. — Calo- 
mel and opium, cal. and nitre, frictions with melted lard, blis- 
ters, &c. Died. Three cases are next reported who came in 
in a state of collapse, and died under the same treatment above 
noticed, and there seems to be no occasion for reporting them 
in detail. Wm. Reed was admitted, 29th Sept. ; was taken 
yesterday with purging and vomiting, which still continued, 
with severe cramps of arms, legs, &c. ; tongue white; pulse 
feeble ; surface warm ; passed no urine since yesterday evening. 
Treatment. — Calomel and opium, cal. and nitre, frictions with 
melted lard, sinapisms, blisters. Recovered. 

Sept. 30th. Nathan Heird, aet. thirty-seven ; has had diar- 
rhoea for several days ; when admitted was vomiting and purg- 
ing (rice-water) ; tongue white ; pulse very feeble ; severe 
cramps; great thirst; surface cold, covered with clammy sweat; 
passed no urine since yesterday. Treatment. — Venesect., ca- 
lomel and opium, cal. and nitre, saline mixture, ol. ricini, calo- 
mel and aloes, sinapisms, blisters, &c. Recovered. 

The next case, in the reports before us, was Charles Dorsey, 
a negro. He had been ill for several days, and without medi- 



CHOLERA TREATED ON AN ANTIPHLOGISTIC PLAN. 127 

cal treatment; none was instituted, and he died half an hour 
after admission. 

October 6th. Charles Sterritwill was admitted, set. thirty- 
nine. Intemperate ; was eating fruit yesterday, and overtaken 
with diarrhoea ; when he came in he had frequent light watery 
evacuations; severe pains in the stomach; tongue white; pulse 
full ; surface warm ; passes urine freely. Treatment. — Vene- 
sect., calomel and opium, cal. and nitre, saline mixture, ol. 
ricini, sinapisms. Recovered. 

Wm. Graham, set. twenty-seven, was admitted after having 
been frolicking several days; had diarrhoea yesterday and se- 
vere pain in the stomach ; now purging light fluid matter ; pain 
in the stomach still ; tongue furred : pulse full ; surface warm ; 
passes urine. Treatment. — Calomel and opium, venesect., 
saline mixture, sinapisms. Recovered. 

Oct. 13th. Polly, a negress, aet. thirty-seven ; has been com- 
plaining for two or three weeks ; was taken yesterday with 
vomiting and purging ; cramps ; collapsed ; died one hour after 
admission. No treatment is noted, and we suppose none was 
instituted. 13th October. Lawrence Cholhous, set. forty-seven; 
has been sick for two weeks ; collapsed ; died in six hours ; no- 
thing said of treatment. Oct. 14th. Elizabeth Carsvell. Has 
diarrhoea, supposed from eating cabbage ; was seized with severe 
cramps this morning, and has frequent watery evacuations, 
with severe pain of the stomach ; tongue white ; pulse full ; sur- 
face warm ; passes urine. Treatment. — Venesect., saline mix- 
ture, cal. and nitre, ol. ricini, sinapisms. Recovered. Oct. 
17th. Ann Goff, set. thirty-seven. Has been sick for a consi- 
derable time ; very intemperate ; when admitted no vomiting, 
but frequent light watery evacuations ; cramps of the legs ; 
severe pain in the stomach ; tongue brown ; pulse very feeble ; 
surface covered with sweat ; has passed no urine for three days. 
Treatment. — Calomel and opium, frictions with melted lard, 
injections, saline mixture, sinapisms. Recovered. 

It seems proper that we give a brief explanation of this sys- 
tematic plan of treatment which was pursued by Dr. Mackenzie. 
We observe that, in the latter part of his practice, he bled 
wherever the pulse was full, and the surface warm ; but, in a 



128 EPIDEMIC CHOLERA. 

few cases, the opposite state of the pulse and skin did not 
deter him from the use of the lancet, and sometimes with success. 
He usually took from sixteen to eighteen ounces; but he, like Dr. 
Carrere, adopted, as a rule, when he bled, to let the blood flow 
till there was sensible mitigation of pain, or a brighter color in 
the blood. 

Calomel and opium in combination, as a first remedy, was 
given in doses, from the first, from two to ten grains, and from 
one to three grains of opium ; where the smaller doses were given, 
they were repeated at short intervals of one, two, or three 
hours. Where a full dose of both was given, it was succeeded 
in an hour or two by calomel, in from two to ten grain doses ; 
nitr. pot., five grains; and repeated every two or three hours. 
Where the bowels became torpid, or there was harassing small 
passages, five or ten grains of aloes were added to the calomel. 
In protracted cases, or where there was no manifest benefit 
from sinapisms, blisters of cantharides were used. The saline 
mixture was a mild adjuvant in all cases, and appeared, in 
almost every case, to afford some mitigation, — this was R. Carb. 
Sodae, 5j- ; 01. Sassafr., gtt. v. ; Tinct. Opii, gtt. 1. vel lxx. ; 
Aqua, ^vj. ; table-spoonful every half or whole hour, or two 
hours, according to the urgency of the vomiting, or pain, or 
sickness of the stomach. 



SPECIALITIES IN THE EPIDEMIC, 1832. 

In giving a brief abstract of the cases treated by Dr. Car- 
rere at the Hospital No. 2, we wish here to notice some inte- 
resting circumstances connected with the first case of a really 
malignant character. "The patient," says Dr. Carrere, "was 
in articulo mortis when brought in ; saline injections were used, 
after which the temporal artery was opened, and about a pint 
of blood obtained." About the time of the admission of this 
case, or a little anterior, experiments were made upon cholera 
patients by injecting their veins with a solution of common 
salt in water. Such experiments had been made at New York 
and Norfolk. Prior to this, we had been led to speculate on 



SPECIALITIES IN THE EPIDEMIC, 1832. 129 

this subject from reading the dissections of Dr. Diffenbauch at 
Berlin. By those dissections it was found that there was a 
strong tendency to coagulation of the blood in cholera. Sub- 
sequent observation has convinced us that, although a frequent 
occurrence in our cholera cases, it does not obtain to the same 
extent that it did at Berlin in 1831. 

The blood having been seen so constantly dark, and coagu- 
lation prevailing so much, or a tendency to solidification of the 
blood, led us to imagine that any agent which would have the 
effect of preventing coagulation, and, at the same time, restore 
the proper fluidity and floridness, would be a useful remedy in 
cholera. In reflecting upon this subject, we were reminded of 
what we had seen, when a boy, at the butchers' shambles, 
where we have seen them prepare the blood of hogs for what 
has been called blood-puddings. This is done by catching the 
blood, as it flows from the arteries, into a vessel, into which 
there is first put a small quantity of common salt, and then 
beating the blood briskly with a small stick, while it flows into 
the pan ; by this process the blood remains fluid and florid. In 
this procedure we see, then, that the salt has the effect of 
keeping up the natural color of blood. Every one, we suppose, 
is aware that by beating the warm blood of healthy animals, 
by means of a small rod, that the fibrine will collect into shreds, 
and become attached to the rod. We had hopes that we could, 
by the use of salt, prevent, in some degree, the tendency to 
coagulation of the blood, and thus prevent the separation of its 
ingredients, — we mean by salting the blood. 

We wish now to give the particulars of a case in which in- 
jection of the veins was applied. Dr. Carrere says : " the patient 
was extremely ill; extremities cold; voice husky; skin on the 
hands shrivelled ; extreme prostration ; pulse scarcely percep- 
tible ; sensible when spoken to, but was extremely dull, and 
seemed to suffer the agonies of malignant fever." Upon ex- 
amining his arm, the cephalic vein could not easily be found, 
particularly in the colored skin, owing to the great diminution 
of the size of the vein. It was discovered, and laid bare a rea- 
sonable distance, and was now found not to exceed in size that 
of small twine. There was some little difficulty in making the 
9 



130 EPIDEMIC CHOLERA. 

necessary puncture, with a sharp lancet, for the injection-pipe; 
this was done by elevating the denuded vein on the end of a 
probe. Two drachms of common salt were dissolved in four- 
teen ounces of water; this was injected slowly into the vein at 
the temperature of about 98°, the standard of Hunter. In a few 
minutes the patient became more animated, his pulse improved 
considerably, and the surface became in a slight degree warmer; 
in short, we were much pleased with the effects of the remedy. 
But it was soon seen that the improvement was not progres- 
sive, and we observed that the contracted state of the super- 
ficial veins continued. Believing that the blood was not only 
darker than natural, and disposed to coagulate in the vessels, 
but that the quantity was much diminished, we resolved upon 
filling the veins with simple water, not deeming it proper to 
introduce so much saline matter into the circulation. An effort 
was made to inject water; but it was soon found that it would 
not enter into the vessels, owing, as we suppose, to want of 
affinity between the water and the living blood. Not succeed- 
ing in this, we resolved upon injecting another portion of the 
saline injection into the foot ; accordingly, a vein was opened 
on the upper side of the foot, and about fourteen ounces of 
salt water injected. This was attended with a little further 
amendment, and the circulation being now somewhat improved, 
a vein was opened in the arm, and a little blood obtained. A 
branch of the temporal artery was now opened, which bled 
freely, and the blood was florid. We now believe the bleeding 
was improper; but no doubt the case was too far advanced to 
admit of any hope of restoration. It will be recollected, how- 
ever, that by many of those who had treated cholera in Europe, 
as well as in this country, bloodletting was much insisted on ; 
but the precise circumstances under which it could be benefi- 
cially applied was still matter of great uncertainty. It has 
been remarked by Dr. Carrere that this patient died in a few 
hours, without having furnished anything decisive as to the 
advantages or disadvantages of bleeding, or the salt injection. 
Dr. Carrere reported a second case of injection of the veins. 
" In the afternoon, the injection of Nifcr. Pot. 3j-> in Ibj. of warm 
water, was introduced into the vein of the arm, and it produced 



SPECIALITIES IN THE EPIDEMIC, 1832. 131 

a slight reaction ; pulse perceptible at the wrist for awhile ; 
pulsation of the heart about one hundred and thirty in the 
minute ; the patient complained, during the operation, of great 
pain in the shoulder and back ; the pain of the back he com- 
plained of during the whole day; he wished very much to have 
some wine, a small quantity was given him, which sat pretty 
well on the stomach; he stated that, a short time after the ope- 
ration was commenced, he felt great heat about the heart; 
appeared as if he was going to faint, but rallied immediately, 
and stated that he thought there was a Spaniard who struck 
him with a knife in the heart. The first evening he was in the 
house he made the same remark." This patient, after having 
rallied wonderfully, died several hours after the injection, so 
that we have no doubt he lived longer than he would otherwise 
have done ; but, as the case was attended with some interesting 
circumstances, and the hospital physician, owing to a great 
pressure of business, could not be as minute in his remarks as 
seemed desirable, we have thought proper to notice a few ad- 
ditional facts connected with the case, and which we published 
in our medical journal for 1832. 

The injection of salt having failed generally, we resolved 
upon trying some other agent which resembled it in its proper- 
ties, and which we believed to have the property of restoring 
the fluidity and floridness of the blood. For this purpose we 
dissolved 3j. of Nitrat. Pot. in tbj. of warm water. The cephalic 
vein being prepared, the pipe of the injecting apparatus was 
introduced ; but we soon found that the blood would not easily 
receive the fluid. Being foiled in our effort at injecting the 
nitrous solution by the force obtained by the height of the 
column of water, we bethought ourselves of pressing the fluid 
through the small tube by stroking down with the thumb and 
forefinger; in this way we could apply considerable force, and 
we soon succeeded in passing about an ounce of the fluid into 
the vein ; as it passed in, the patient cried out with an agony 
of pain; he continued to cry out at each injection. Upon 
questioning him as to his feelings, he said he had a rending 
pain in his shoulder. He soon complained of its passing in- 
wards towards the heart, when, all at once, he started up as if 



132 EPIDEMIC CHOLERA. 

suddenly alarmed. His face became slightly flushed ; the sur- 
face, -which had been extremely cold all day, became warmer ; 
his pulse stronger ; his expression more animated ; and he ex- 
pressed himself as stated above. 

He now proceeded clearly, and with considerable energy of 
expression, to inform us, that he had suffered all day from cold 
feet, whereas he now was warm, and felt a pleasant glow over 
his whole body, and that we had infused new animation into 
his system, for which he wished to give us a thousand thanks. 
This was evidently a man who had seen better days, and was 
of more than ordinary mental endowment. The propriety and 
energy with which he was enabled to express himself, after 
lying all day exhausted below the power of articulation above 
a whisper, was highly gratifying, as well from the impression 
made by so sudden a change so unexpected, as by the momen- 
tary hope that the remedy might possibly be attended with 
success. We left the patient with a feeling, that if his disease 
had been any other than cholera, we should have looked most 
confidently for a restoration. The disease had too far im- 
paired his system, and a few hours of seeming respite termi- 
nated in a return of collapse, and death closed the scene. 

Our experience, so far, in respect to the injection of the 
veins for the cure of cholera, leaves us little or nothing to ex- 
pect from this practice, unless we can devise some other mode 
of employing it. Should it be thought advisable to make fur- 
ther trials of this mode of treatment, there appears to be two 
points to which our attention should be directed : 1st. To find 
the proper material for the injection. 2d. To decide to what 
extent as to quantity we should carry the injection, and as to 
the repetitions which may be requisite or allowable. 

We shall not speculate upon this subject, since we have no 
positive information to offer. It would seem reasonable, how- 
ever, to look to some fresh animal matter, dissolved in water ; 
suppose we say a very small quantity of the fresh brain of some 
slaughtered animal, with or without a very minute quantity of 
nitrate of potass. Should we live to have opportunity, we may 
yet attempt to investigate this affair still further. As to quan- 
tity, the empty state of the bloodvessels would seem to indicate 



SPECIALITIES IN THE EPIDEMIC, 1832. 133 

a large quantity of fluid ; but we must remember that the heart 
and arteries can only accommodate themselves to small and 
gradual changes of the quantity of the blood. The necessity 
which exists for a due distension of the vessels is well known, 
and we may readily believe that over-distension would prove 
hurtful, and, when urged too rapidly or too forcibly, might 
prove fatal : dissection shows a diminished calibre of the veins. 

This view of the subject would seem to lead us to the con- 
clusion that there would be most hope from repetition, — a 
moderate quantity being injected, we may note the effect ; if 
the patient appears to be benefited, this would seem to indicate 
that we have injected enough for the time; it would seem to be 
proper now to use the most scrupulous care, and repeat the 
moment that we find our patient falling off. 

But, while we express as our opinion that the injection of 
the veins has not been sufficiently tested, we wish to express 
our apprehension that we can only hope to combat the fault 
in the system, so far as the blood is concerned. If the secern- 
ing vessels, and the nervous influence governing these secerning 
organs, are in a state of derangement, our efforts to relieve will 
be transient. But, as there is a mutual dependence between 
the blood and the powers and organs alluded to, it may be that 
improving the condition of the blood may improve other asso- 
ciated parts. Besides, the secernents may be improved, and 
yet so much diseased as to be unable to recover under the op- 
posing influence of the blood now somewhat improved, the 
blood being still deficient in quantity and defective in quality. 
We must not forget, in our reflections on this subject, to bear 
in mind, that the injection of the veins has never been em- 
ployed, we believe, except in the stage of collapse ; and every 
one is aware of the slender hopes, in this stage of the disease, 
under any treatment. We would not wish to be understood 
that we recommend this remedy at an earlier stage of the dis- 
ease, for the present. The remedy, so far, has not been at- 
tended with results at all favorable to our hopes in using it ; 
and so many patients are affected with cholera, in which there 
does not seem to be any tendency to collapse, that to use a 
doubtful, or any other than what may, reasonably, be consi- 



134 EPIDEMIC CHOLERA. 

dered safe, is not justifiable ; still, there are desperate cases in 
which we may experiment with propriety. 

Having disposed of our own experience, which is quite limited 
in respect to injection, we now turn to the apparatus by which 
we accomplished our injections into the veins, which was, per- 
haps, as simple as anything that could be made use of. It 
consists of a cylinder of tin, which would hold a little more than 
a pint, and terminated in a funnel, the pipe of which was made 
so small as to allow of a small silver tube to be introduced, and 
the point of this second tube small enough to enter the punc- 
tured vein, this point having a small knob, so that its other- 
wise sharp point might not perforate the coats of the vein ; 
to the larger end of this injecting tube there was tied about 
three feet of cat's intestine, dried for that purpose. We found, 
on trial, that considerable pressure could be applied by pressing 
the fluid towards the vein by the thumb and forefinger. The 
tube being transparent, we easily avoid the injection of air. 
We are reminded here of an observation of Dr. DifFenbauch, 
i. e., that the blood of healthy persons will not unite readily 
with that of cholera patients ; and hence the difficulty, and in- 
deed, impossibility, of accomplishing transfusion with suc- 
cess. We have seen that the same difficulty attended our 
efforts to introduce warm water into the veins of cholera 
patients. So far as the blood is concerned, we are inclined to 
believe that the saline injection, in good degree, corrects the 
fault in the blood ; but it is not sufficient that we merely im- 
prove the mass of blood present in the veins, but we must 
change the morbid action of the capillaries, and the nervous 
energies also must be corrected, and hence, probably, we may 
derive the true explanation, that the improvement of the pa- 
tient, in all cases, has been temporary. 



DR. REES ON TRANSFUSION. 



In the Medical News, published by Blanchard & Lea, we 
have some observations upon transfusion, by Dr. William 



DR. REES ON TRANSFUSION. 135 

Marcet. We have first the formula recommended by Dr. Owen 
Rees : "R. Chloride of Sodium, §iij. ; Phosphate of Soda, aj. ; 
Carbonate of Soda, 3iss. ; Sulphate of Soda, §ss. This com- 
bination is to be dissolved in a little water, and the solution to 
be gradually diluted with small proportions of distilled water, 
at the temperature of from 58° to 63° Fahr., occasionally 
testing it with a urinometer, until it has attained the specific 
gravity of 10*30 ; the whole fluid is then to be heated to 98° 
Fahr., when it will be ready for use. 

" Dr. Owen Rees considers that the specific gravity of his 
solution ought to be the same as that of the serum of blood, 
and assumes it, therefore, to be as high as 10-30. I may, per- 
haps, however,be allowed to observe, that serum, containing 80 
parts albumen, besides 8 or 10 parts of salts, dissolved in 1000 
parts of water, must have a much higher specific gravity than 
if it consisted only of a solution of 8 or 10 parts of inorganic 
salts in 1000 parts of water ; and consequently, that the specific 
gravity assumed for the above solution far exceeds what it 
ought to be, if the gravity is raised by saline matter only. 
This assertion, moreover, is proved by experiment, as I have 
ascertained that the specific gravity of a liquid containing 
1000 parts of distilled water, and 10 of inorganic salts, such 
as occur in the blood, according to the proportions given by 
Nass, in his analysis of the fluid, which does not exceed 1*004 
at the temperature of 68° Fahr. 

"Perhaps, therefore, I may recommend the following for- 
mula : Water, Ex.; Chloride of Sodium, xxxj. grains ; Phosphate 
of Soda, v. grs. ; Carbonate of Soda, vj. grs. ; Sulph. Soda, j. gr., 
which is to be heated to 98° Fahr., when required for use. The 
specific gravity of the above solution is 1*004 at 68°, and be- 
tween 1*000 and 1*001 at 98° ; its composition is as nearly as 
possible identical with that of the serum of the blood, deprived 
of its organic principles. The following are the calculations 
from which this formula has been obtained. According to 
Nass, 1000 parts of blood contain 7*999 of salts. 

Soluble Salts in the Blood. Insoluble Salts. 

Alkaline phosphates, . 0-823 Lime, 0-183 

Sulph. soda, .... 0-202 Phosphoric acid, . . 0-201 



136 EPIDEMIC CHOLERA. 

Soluble Salts in the Blood. Insoluble Salts. 

Carb. soda, .... 0-956 Sulph. acid 0052 

Chlor. sodium, . . . 4-690 Magnesia, .... 0015 

Silica, 0-043 

Oxide of iron, . . . 0-834 

" The number 6*671 for the salts is, however, under the 
average, if we consider other analyses of blood made by trust- 
worthy chemists. We may assume it to be at the highest about 
10. According to the proportions given in the analysis of 
Nass, 10 parts of the soluble salts of the blood dissolved in 
1000 parts of water, will consist of 

Alkaline phosphate, 1-233 

Sulph. soda, 0-302 

Carb. soda, 1-433 

Chloride of Sodium, 7-030 

" Ten ounces of the solution will contain, therefore, a little 
more than the hundredth of an punce of phosphate of soda, 
and if a fluid ounce of distilled water weighs 437*29, or about 
5 grs., the proportion of the other salts have been calculated 
by the same process." 

Chemists who have been laudably engaged in experiments 
and analyses of the blood, deserve great praise ; but while we 
would applaud, and hope their labors may eventually succeed, 
we wish to express our apprehensions, that their views and 
proposals are too chemical. We find, in cholera, that some 
hurtful cause has disturbed the normal relations of the several 
integrant parts. It has been said correctly, we think, by the 
American father of physic, Dr. Rush, that " disease is ever a 
war with nature." The disorder within may be viewed as a 
sort of warfare — changes take place, and parts and parcels 
separate from their normal posts, and the grand sustainers of 
life are decomposed, and a part of their integrant substance 
rejected, driven out; and sluices are opened, and fluids abso- 
lutely essential to life are sent forth, so to speak, forwards and 
backwards through unwonted channels. 

We have seen the inward tumult, and would replace what 
has gone forth from its usual share in the sustentation. Such 
the dilemma, the chemist would replace the thing (the serum 



DR. REE8 ON TRANSFUSION. 13T 

of the blood) that has been rejected. It seems proper that we 
inquire here into the cause of such rejection of the serum. 

Physiology opens to our view one grand system, constructed 
of several systems of organs, each of which has its peculiar 
office as an integrant ; and each co-ordinate system co-operates 
in the scheme, making the grand living body. It follows that 
all these co-ordinates must harmonize in the constitution and 
sustentation of the living economy. The term vis a tergo seems 
to be obsolete, but whatever term we may adopt for the con- 
dition which gives play to the great circulation, there must be 
harmonious action of all co-ordinates to sustain the circulation. 
The brain and nerves have their offices — the blood must co-ope- 
rate with the nervous system, the sanguiferous system, the 
lymphatic system, nor less important, as an integrant of the 
grand system, than any of its co-ordinates, is the blood. This 
physiological sketch will serve to illustrate the pathology of 
cholera, so far as will answer our present purpose. We shall, 
therefore, not enter into the depths of the plastic or ultimate 
ends of the organs which we have noted ; this would lead us 
into a field which we neither need or desire to enter upon. 

The abnormal condition which it is our purpose to inquire 
into at this time, as it stands related to cholera, shows us a 
deteriorated blood, which is not in harmonious action with the 
nervous system ; and, of course, this is attended with a want of 
affinity between the terminal nervous fibrils of the inner coat 
of the vessels and the blood itself. 

We use the term vis a tergo as a convenient term for express- 
ing a condition or order of things growing out of a normal co- 
operation of whatever aids in the grand scheme of the circula- 
tion ; and in this scheme we suppose the terminal nervous 
fibres of the bloodvessels act an important part. On the 
nervous fibres we suppose any extraneous matter which we 
might inject would first act ; the impulse thereby given will 
carry the blood to the lungs ; here, again, the nerves of the 
lungs must co-operate in the oxidation of the blood, and there- 
by withdraw the carbon. We have seen that, in cholera, as 
the disease advances, all the physiological relations are broken 



138 EPIDEMIC CHOLERA. 

up, new impulses are present, new affinities and new loedentia 
reign. 

If such be the state of things, can we determine, a priori, 
that if we inject water containing the same material that was 
thrown off in the serum of the blood, that it will exert and re- 
ceive the same affinities as existed in the mass of blood, when 
all things were in the normal state. We have seen that " dis- 
ease is a war with nature," and the very thing that has just 
been cast off may not be more likely to restore harmony than 
some agent which will excite new impulses and new affinities 
in all the co-ordinate structures and powers. What that agent 
can be, or whether there be any such thing, can only be deter- 
mined by experiment. One thing is certain, that as the serum 
diminishes in the blood which remains in the bloodvessels, the 
carbon must accumulate in undue quantity. Will this not re- 
quire additional labor on the part of the lungs, and have not 
the lungs, as one of the grand integrants of the general 
system, already failed in the office of decarbonization ? This 
suggests the inquiry, can we help the lungs while we attempt 
to help the blood ? 

All the living functions are maintained by a vital appetitus, 
by which we mean an elective power. Then, if we introduce 
into the system what is chemically a real similitude, to a part 
that, in a general disorder, has been rejected, can we rely upon 
the procedure for a vital acceptance of material that is non- 
vital, unless it be functionally accepted ? 

We are reminded here of the anxiety constantly seen in our 
patients, and still more in their friends, to cause them to take 
food, with but little regard to the condition of the stomach. 
Aware that strength comes from eating, they think only of 
the supply, not knowing that, in all cases of unsuitable supply, 
more or less evil will grow out of it ; since whatever is not 
digested will irritate and increase any disorder present in the 
system. Indeed, we see that, in cholera, even before we are 
at all aware of anything being amiss, a too free meal or small 
quantities of articles that are hard of digestion, instead of its 
calling forth the vital forces, or that functional appetitus.bj 
which we exist, we have tumultuous disorder originated by it. 



DR. REES ON TRANSFUSION. 139 

We have seen, that if there be a choleraic atmosphere, and 
we are admonished by flatulence, a slight diarrhoea, &c, that we 
are morbidly impressed, the use of some carminative, and a 
little abstinence, will ward off impending danger. May we 
not hope that something similar may be possible in otherwise 
hopeless cholera, and, instead of crowding the vessels with 
injections having the stimulus of healthy blood, something 
much milder in its properties may be better suited to the 
crippled nerves of the heart and bloodvessels, also those of 
the lungs. We offer these reflections partly with a hope that 
suitable experiments may still be made, and partly to express 
our decided belief that it is vain to expect, by returning saline 
combinations, to replace the waste of decomposed blood. There 
is no more hope — nay, we think, not so much hope of success 
as by something milder, and this we offer on the ground that 
there is no more reason to expect that the salification of broken- 
down blood can be vitalized by saline injections, than there is 
that food put into the sick stomach can be digested and assimi- 
lated into the plastic uses of the system. But if we see mild 
agents composing incipient cases of cholera, as has so often 
been done by the use of mere carminatives, there would seem 
to be ground for hope that we can sanguify the system when 
half dead, by some mild remedy, rather than by returning what 
the general internal disorder has expelled, or what is similar to 
it. The grand system of man is a tissue of appetites — disorder 
ruling, it is only by experiment and induction that we can at- 
tain curative knowledge. 

It has been our design, in the foregoing sketch, to awaken 
attention to affairs that may hereafter lead to greater success 
in the treatment of cholera by means of injection of the veins. 
We have understood that the veterinary practitioners in Russia 
treat their cases by veno-injection, with a view of economizing 
the expenses attending the purchase of medicine, and we have 
read, somewhere, in the works of Goldsmith, that sweet milk, 
injected into the veins of one of our domestic animals, will oc- 
casion speedy death. The former fact goes to show that there 
may not, after all, be any great risk in the cautious use of in- 



140 EPIDEMIC CHOLERA. 

jections into the human veins. The latter would teach us to 
be very cautious of things seemingly mild, but which, never- 
theless, might be poisonous when injected into the veins ; 
nor can we venture, a priori, to decide that compounds nearly 
similar to the blood will be beneficial, or even safe, until we 
have tested them in forlorn cases by experiment. 



ABATEMENT OF CHOLERA. 

Returning to our observations on epidemic cholera at Balti- 
more in 1832, we have to remark, that as the disease abated 
in its career, it abated in its virulence, and we think this has 
been one of the most steady traits of its character, and, no 
doubt, led physicians to imagine sometimes that they had fallen 
upon a more successful practice than others. Thus, it some- 
times appears that the disease seizes with great virulence, and 
many die ; the physician, seeing no well-marked advantage 
from remedies, tries several in succession, each of which has 
some r time been supposed to have been useful in the practice 
of others. Presently he finds one to answer beyond his ex- 
pectations. Thus unexpectedly relieved from his difficulties, 
and his mind relieved from the distress inseparable from the 
devastation which cholera makes at its acme of virulence, he 
suffers himself to conclude that all the success is owing to the 
new remedy, or at least in greater part ; forgetting that all 
may be ascribed to an ameliorated condition of the disease itself. 
In this way, too, it may sometimes happen that hospitals that 
are opened later in a cholera season will exhibit a more favor- 
able report of cases than those that are opened earlier, although 
it is known, that with almost no exceptions, cholera, however 
long it may linger in the stages of cholerine, or cholero-dys- 
entery, in a neighborhood, assumes its acme of virulence soon 
after making its epidemical lethalic appearance. Malignant 
cases may turn up throughout a season, but not in a degree to 
disprove the position we have assumed. The circumstances 
here presented are well worth noting, since it has often been 



ABATEMENT OF CHOLERA. 141 

the leading ignus fat mis that has led physicians, in their 
philanthropic hopes, to visit cholera districts, believing they 
had means of cure, only to be greatly disappointed in every 
such adventure. 

The first case of Malignant Cholera which we saw 
in Baltimore in 1832. — We judge proper to enter more fully 
into the particulars of this case, than was done by Dr. Mackenzie, 
who, at that time, was too much occupied in making his general 
arrangements in the hospital to enter into minute details of 
cases. We saw this patient about three-quarters of an hour 
before his death. He was a frail old man, 75 years of age. 
He had the contracted choleraic face in greater degree than any 
one we ever have seen, and it could readily be distinguished 
from the wrinkles of old age. We need not describe the 
symptoms, but would remark, that the patient retained his 
senses till within a few moments of his death, and insisted on 
being bled. We could not indulge the slightest hope of his 
recovery from any treatment ; for, although as yet we had but 
a slight acquaintance with cholera in its malignant stage, the 
fatal tendency of the case was too clearly portrayed to leave 
any difficulty in forming a prognosis of it. Nevertheless, we 
consented to bleed him, because we felt confident that, under 
existing circumstances, it could not injure him, and we were 
anxious to try whether he could be bled, and to ascertain the 
appearances of the blood. A vein being pretty freely opened, 
we obtained a mere trifle of blood, which was very dark colored ; 
indeed, it might be said to be black. Not getting as much as 
would enable us to examine the blood, we opened a vein in the 
other arm, and, by a good deal of rubbing, we got about two 
ounces. Finding that no more blood could be obtained, we 
now turned our attention to other remedies. Dr. Mackenzie 
states that an enema of salt and water had been given. We 
gave the patient a large tumblerful of salt water. We had 
previously resolved upon trying the use of salt water in this 
way, as well as by injecting the veins. In this case, neither 
the injection by the rectum, nor the salt water by the mouth, 
came away ; all remained within. The countenance of the 
patient suddenly changed, his respiration became much more 



142 EPIDEMIC CHOLERA. 

laborious, his eyes lost their lustre, and he did not answer 
questions put to him, and, in a few minutes, he quietly expired. 

We discovered in this case that but little could be expected 
from the external application of dry heat, owing to the in- 
cessant and ungovernable disposition of the patient to toss 
about, so that nothing could be regularly applied, even while 
a nurse stood beside him for the purpose of keeping the bags 
of warm sand to his extremities. We afterwards learned, 
early in the irruption of the epidemic, that warmth could not 
be regularly applied to patients in this disease, and we soon 
abandoned all attempts at applying heat, except to the feet, 
which was done by means of sand-bags applied to the soles. 
Indeed, it does not seem reasonable to us, that while a copious 
exudation was going through the skin, that any heat could thus 
be imparted to the body. We therefore resolved upon en- 
deavoring to retain all the heat which might be found in the 
body, by applying long sleeves, and leggins of thick woollen 
baize. So soon as a patient would be got to bed, his skin was 
wiped dry, and the woollen envelopes applied. 

But to return to the case of Brown. We bled this patient 
ourselves. It so happened that a clean strip of white muslin 
was given to us to be used as a ligature ; this was stained with 
a few drops of blood. About an hour after the bleeding, we 
observed that the stain on the bandage was unusually bright, 
and, upon closer examination, we found an appearance of greater 
consistence in the blood forming the stain ; or, as if the coloring 
fluid had more body than usually exists in blood; and, in- 
stead of the edge of the stain terminating in a margin which 
became paler when it spread, as is usual, it terminated abruptly, 
without the least appearance of any stain from serum. Look- 
ing at the blood in the bottom of a tin pan, it very much re- 
sembled a piece of metal which had been japanned black — it 
was highly polished, and looked as if the surface was covered 
with a pellicle ; and in attempting to touch it with the finger, 
one had the impression that the surface would give resistance, 
but when the finger came into contact, gave to the touch the 
perception of an oily fluid. In short, we decided that, in this 
case, the blood was decomposed, and deprived in part of its 



CASE OF SUCCESSFUL ANTIPHLOGISTIC TREATMENT. 143 

serum, while the remaining mass was more closely amalgamated, 
and the color more intense than usual, whether we look to the 
blood in the pan, or the stain on the muslin. We were led to 
the conclusion, which we have not found reason to change, 
that whatever might be the nature of cholera, or whatever 
might be said of recoveries from collapse, whenever the blood 
of a patient takes on the condition which we have just described, 
they are irrecoverably gone, the blood being wholly unfit for the 
purposes of life ; death is now as certain as if a bullet had passed 
through the heart. It is very certain, however, that this con- 
dition of the blood does not always exist when the symptoms 
of collapse are seemingly present. Our opinion of the matter 
is this : the danger which attends cholera grows principally out 
of a tendency to a certain kind of morbid debility, which we 
recognize by a cold skin, clammy, cold sweats, cold tongue and 
breath, spasms, dejections from the bowels, emesis, &c, asso- 
ciated with, or arising out of, this state of the system-; there is 
a tendency to decomposition of the blood, and our observations 
lead us to believe, that when it takes place, it is quite suddenly, 
and always a fatal occurrence. Patients do sometimes appear 
to labor under the symptoms of collapse, and after remaining 
more or less time in this state, from the period of a few hours 
to some days, they begin to revive, and sometimes recover ; 
and these cases occur under every kind of treatment. In such 
cases, the disease is only progressing into an incipient stage 
of collapse. While the blood retains its integrity, and there 
is a sufficient quantity, the patient hangs on to life, however 
feebly ; but a change of the blood, amounting to decomposition, 
is incompatible with life, and any continuance of the symptoms 
is but a stage of profound asphyxia, admitting of no resusci- 
tation. 



CASE OF REMARKABLE AND SUCCESSFUL ANTIPHLOGISTIC 
TREATMENT. 

From the Hospital No. 1 we had the case of William Oliver, 
reported by Dr. Mackenzie, and in it we have a strong speci- 



144 EPIDEMIC CHOLERA. 

men of the advantages of the antiphlogistic plan of treatment. 
We have already informed the reader, that, excepting opium, 
we used no stimulants, either in our hospital or private practice, 
during a considerable part of the existence t>f cholera. We 
were informed that the patient took, before he came in, five 
grains of quinine at a dose, afterwards, three grains every 
hour ; also, full doses of camphor and ammonia in combination, 
with large doses of calomel. Shortly after his admission, he 
had a small watery evacuation, of a dark brown color ; pulse 
feeble ; tongue covered with a dark brown fur, surface warm ; 
slight pain in the stomach. Does not recollect having passed 
any urine since he was taken sick. There is yet no reaction, 
and yet Dr. Mackenzie ventured to discontinue tonics and 
stimulants, and relied on calomel and nitrate of potass, and 
the alkaline solution noticed in different parts of this work. It 
is said that the "surface was warm," but this must be under- 
stood to be moderately so, since Dr. Mackenzie thought proper 
to direct " hot sand to the extremities," when the patient came 
in. The day after his admission, he had several dark, bilious 
passages ; " the tongue is brown ; the pulse improved, small 
quantities of urine passed." The same medicine continued. 
Second day after admission : free urinary discharges took 
place, and he had dark passages, very offensive. But what is 
most particularly to our purpose, the stimulant plan was 
dropped, and refrigerant medicine given, and the patient 
rapidly recovered. This case shows in a strong manner the 
safety and advantage of the free use of calomel, and that a 
moderate ptyalism is no obstacle in the way of recovery. The 
particulars of this case go to support the opinion which we have 
elsewhere expressed, that we never, in any case, could observe 
well-marked benefit derived from the use of stimulants or 
tonics. On the contrary, we have again and again seen cases 
that were stationary, or growing worse, under the use of 
stimulants or tonics, rapidly grow better upon changing from 
the stimulants to a plan strictly antiphlogistic ; and as regards 
medicine, no one, or any combination, was so obviously and so 
uniformly useful as pretty free doses of calomel and nitrate of 
potass, preceded mostly by a large dose or two of opium and 



SPECIALITIES IN PRIVATE PRACTICE IN BALTIMORE. 145 

calomel. These remarks were published in our Journal for 
1832, and we have had no cause to alter our opinion, except in 
one season, when cholera broke out in the Baltimore Alms- 
house, and about one hundred deaths took place in a few weeks. 
There was then a few sporadic cases in the city, in which we 
used Sp. Turpentine in dessert and even tablespoonful doses, 
and with decided success. From what we have seen of the 
effects of turpentine in the treatment of puerperal fever, we 
must view it as being mild and peculiar in its stimulant effects. 
We have now given nearly all the information derived from 
our hospital practice in 1832; but we have been led to believe 
that a brief sketch of circumstances, which came under our no- 
tice in private practice, are worthy of preservation. It seems 
to us proper to precede our professional remarks by a brief 
notice of the localities of the epidemic cholera of 1832. 



SPECIALITIES IN PRIVATE PRACTICE IN BALTIMORE IN 1832. 

It will be observed, by turning to our hospital reports, that 
the disease first appeared in Buxton Lane ; but it subsequently 
spread through most of the city, and was by no means most 
prevalent in localities liable to bilious diseases of a high grade; 
but, especially, there was no affinity in this respect between 
places in which the yellow fever usually has prevailed at long 
intervals in former years and those in which epidemic cholera 
showed itself. In some places, crowded streets and alleys 
suffered most; but there was exceptions to this, so that, in 
some instances, where we might have looked for cholera to 
exist, it appeared slightly or not at all, while other localities, 
remarkable for their salubrity, suffered in greater degree than 
those in which yellow fever is most commonly seen. 

A very large part of Baltimore is wholly exempt from yellow 
fever at all times ; but it was seen that cholera was not con- 
fined to any fixed bounds, whether we look to location simply, 
or location associated with general healthiness. Several per- 
sons were said to have died in one part of Liberty Street, most 
of whom were persons of respectability. One little girl, aged 
10 



146 EPIDEMIC CHOLERA. 

seven years, was, we believe, the first victim to cholera in the 
epidemic of 1832. In Baltimore, intermitting fevers are not 
so common in yellow fever locations as in our suburbs, and it 
may be said of cholera, it did prevail in yellow fever districts, 
but prevailed most in districts subject to intermittents, with 
one exception, in Liberty Street, where we are not aware of 
intermittents having prevailed for many years. It is proper 
to observe here, that that part of Liberty Street which suffered 
most from cholera is alluvial or made ground, there having 
been, in former years, a large gully, which served as a drain 
for a large portion of the upper part of the city ; but this has 
long since been filled up, and the parts around have been well 
improved by clean substantial buildings. Notwithstanding this 
apparent affinity between the locations of intermittents and 
epidemic cholera, but few intermittents were seen during this 
summer. At one time, about the end of August, our diseases 
assumed more of a bilious character, and afforded strong hopes 
in our mind that cholera would decline ; but, in a few days, 
febrile diseases assumed more of the choleraic aspect, and 
bilious affections declined. In making this remark, we wish to 
be understood to speak of pure bilious affections, which are 
known by the term, bilious fever, since we found bilious de- 
rangements of various kinds to prevail extensively in choleraic 
patients whenever cases became protracted, and we have already 
remarked that malignant cholera, as it appeared with us, wore 
more of the livery of yellow fever than of common remittents 
and intermittents. 

Deeming it our duty, as health physician for the city, on the 
outbreak of cholera, to give some advice respecting precautions 
as preventive of the disease, in alluding to diet, we suggested 
that it might only be necessary to diminish the usual quantity 
of food, observing a guarded temperance ; but before the disease 
had long existed, we had reason to change our opinion, in con- 
sequence of having seen some cases of cholera arising from the 
use of certain articles in which the effect followed the use of 
the articles so speedily as to leave no doubt of the evil, which 
sometimes arose from partaking of fruits and many of our 
common vegetables. 



SPECIALITIES IN PRIVATE PRACTICE IN BALTIMORE. 147 

It may not be amiss to give a recital of some of the more 
remarkable cases that came to our knowledge. A respectable 
woman, in the country, informed us, that her son and two fel- 
low-laborers in a factory, being about to visit the city, she 
strictly charged him not to eat of water-melon, which was re- 
puted to be particularly unwholesome. Deeming her caution 
the result of timidity, they purchased a small melon, and ate 
it on the way home, and were all three presently overtaken 
with severe sickness and vomiting, and reached home with diffi- 
culty. The disturbance went off after some time. Had they 
eaten a little more, or had their systems been much disposed to 
cholera, death would probably have been the result of the dis- 
obedience. 

Another instance of immediate suffering after eating water- 
melon was related to us by a medical friend. A colored man 
bought a water-melon in market, and ate it, as he probably was 
accustomed to do ; immediately after having done so, he was 
seized with violent colicky pains. A bystander, seeing his dis- 
tress, desired him to hasten to the dispensary, some squares off. 
He set off, and ran till he dropped down in the street, wholly 
unable to proceed further. A physician of eminence did all he 
could for the man, but he died in about seven hours after the 
attack. The following incident was related to us by a friend : 
A colored man was seen sitting on one side of the street, having 
in his possession a water-melon. He was overtaken by an ac- 
quaintance, who asked him, jestingly, what he had there; he 
replied he had a mess of cholera. The melon was shared, and 
eaten by them : early next morning one of them died, and the 
other in less than twenty-four hours. 

A young gentleman, of temperate habits, refused, during 
part of the cholera season, to abstain from the use of vege- 
tables, as the rest of the boarders in the same house were doing. 
While they abstained in the general use of vegetables, he re- 
fused to do so, and contended that cholera was the disease of 
the vicious, and that he could use vegetables and fruit with 
impunity. During the height of cholera, he one day par- 
took of fried egg-plant, and after dinner ate some peaches: 
in a few minutes afterwards, he was seized with violent symp- 



148 EPIDEMIC CHOLERA. 

toms of cholera, and after a few hours of the most agonizing 
sufferings he died. All such cases require copious blood- 
letting. 

The following particulars were reported to us of the case of 
Dr. Cromwell, of Baltimore. This gentleman, while he ad- 
mitted the propriety of a very sparing use of vegetables, in- 
sisted that peaches were wholly innocent. A gentleman seeing 
the Doctor buying, at a time that few persons would have 
ventured to have eaten them, asked the Doctor whether he 
believed them to be a safe article. The Doctor replied, that, 
as a proof of his belief in their innocence, he had just been 
buying some for a sick friend. A few days after this, he par- 
took of plums, cantelope, and peaches, at dinner. In a few 
minutes he was seized with violent cholera, and, notwithstand- 
ing the early use of medical treatment, he died in a few hours. 

Dr. S. B. Martin had a little girl under his notice, who, 
while in perfect health, ventured to eat of green peaches, 
which her playmates refused to do. In a few minutes she was 
seized with severe symptoms of cholera. The children who 
had been with her during the afternoon, and who did not eat 
any of the peaches or other fruit, were not affected with cholera 
during the season. 

We were requested to visit a family, while the cholera was 
raging, to see four children quite ill from having eaten green 
apples ; they were affected with severe symptoms of cholera 
morbus. The doctor had already given them mild emetics, 
which, in every case, brought up the apples which they had 
eaten. These children were treated with appeasing remedies, 
and they soon recovered. We could enlarge to great extent 
occurrences similar to those noticed ; but enough has been pre- 
sented to show that the disease was excited into play by vege- 
tables ; and fruits in particular ; we shall now offer a few re- 
marks upon a few cases of a different kind. 

A young man of correct habits, in good health, was boasting, 
on Sunday, that he had eaten of everything usual during the 
cholera, and that he had no fears for the disease ; he ate freely 
of vegetables ; on Monday he partook freely of cabbage, was 
soon afterwards taken violently ill with cholera, and died before 



SPECIALITIES IN PRIVATE PRACTICE IN BALTIMORE. 149 

daylight on Tuesday morning. This is one of many similar 
cases that came to our notice ; but we need not extend our re- 
marks further. Almost every person was aware of some im- 
pairment of their digestive organs, and that vegetables and 
fruits were improper, either at meals or intermediately. We 
met a few persons who, towards the close of the epidemic, 
boasted of having lived as they always had done and with im- 
punity. But, independently of the risk of cholera from eating 
certain articles, so common were symptoms of indigestion, and 
slight complaints of the stomach and bowels, that the latter 
alone would have required an abandonment of the more indi- 
gestible articles of food or luxury. 

The present writer was directed in the regulation of his diet 
by the condition of his stomach. Aware, before cholera had 
made its appearance in this country, that certain articles of 
food were hurtful to persons predisposed to cholera, he early 
advised the citizens of Baltimore to eat sparingly of whatever 
was hard of digestion, and, accordingly, he continued to eat 
sparingly of the vegetables of the season. As the cholera more 
nearly manifested itself, he clearly perceived that such articles 
began to incommode his stomach, and he was made very uneasy 
at the stomach by eating a little peach and milk. Acidity and 
flatulency and gastrodynia occurred, and kept up a good deal of 
distress for several hours. Several friendly admonitions of this 
sort attended the use of improper food, and also succeeded the use 
of more allowable articles taken a little too freely. Thus ad- 
monished, without stopping in an extreme pressure of business 
to imagine anything unreal, we endeavored, free from any 
anxiety, to regulate our diet according to circumstances. We 
reduced our fare to one sort of plain meat at the same meal — 
bread, butter, potato, and rice, with a very small portion of 
milk, also a little tea and coffee. All things were used in quan- 
ties less — more than one-half — of our former habits. We were 
engaged in the most active duties from six o'clock in the morn- 
ing till ten or eleven at night, with but a few minutes to dine ; 
we fatigued two horses daily for several weeks, and were fre- 
quently knocked up at night : we were always sensible that we 
ate enough. 



150 EPIDEMIC CHOLERA. 

A large majority of cases, which we saw throughout the sea- 
son, did not tend strongly, as far as we could see, to terminate 
in collapse ; for, wherever early application was made, the 
disease was arrested before that stage of the disease was 
reached. But we saw, now and then, cases, with much regret, 
in which the change from ordinary symptoms to extraordinary 
diseased action was so sudden as to leave no room for foresee- 
ing the symptoms that constitute the malignant stage of the 
disease. This will be most easily shown by exhibiting the cir- 
cumstances with some cases on both sides, that is, cases which 
suddenly assumed malignancy, and others which presented 
symptoms quite alarming, but yielded to treatment, because, 
as we suppose, in the latter case the blood still had reliable 
qualities. 

About the time that the cholera was most rife in 1832, Lewis 
Gr. Wells, a colored man, who had devoted several years to the 
study of medicine, under favorable circumstances, had become 
a busy practitioner among our colored people. The cholera, 
having extended, made room for the most active exertion on 
his part, to administer to the wants of those affected with the 
disease. We do not know much of his views or of his treat- - 
ment; but we have been informed that he placed a good deal 
of reliance on dry-rubbing, and was in the practice of ap- 
plying the remedy himself. He was engaged for several days 
in running about among his patients, and almost constantly en- 
gaged in active rubbing, which was calculated, in a high de- 
gree, to exhaust his strength, and predispose him to the disease. 
In passing, for the last time, from his office to his dwelling, 
about twelve o'clock at night, he observed, when near his house, 
to his wife, that he felt a good deal unwell, and if he should be 
overtaken with cholera so suddenly or violently as to render 
him incapable of doing for himself, he wished her to confide the 
case to Dr. Jameson. In a few minutes he reached his home, 
and threw himself down upon the carpet, observing that he 
was very unwell. He was immediately seized with violent 
cramps, particularly violent in his legs. His wife and family 
were directed to rub his legs freely and somewhat hard ; after 
some time he attempted to bleed himself, but did not succeed, 



BLOODLETTING IN SPASMODIC CHOLERA. 151 

owing to the incessant violence of the spasms. At daylight, 
■we were sent for, with a view, as the messenger said, of bleed- 
ing him ; aware of the danger attending the disease at that 
time, and believing this man's life important to his colored 
brethren, we hastened to his relief, and found him in the last 
stage of collapse. He had been lying on the floor since twelve 
o'clock at night, and during all that time he had been under ac- 
tive rubbing, and now cried out incessantly, "Rub down ! rub 
down !" The pulse was gone ; skin and tongue as cold as 
marble ; though still sensible, he was prostrated beyond all 
possibility of recovery. Being in an agony of suffering, we 
gave him a large dose of laudanum, telling him, however, at 
first sight, that his case was too far advanced to admit of the 
slightest hope of recovery. He coolly, and with a degree of 
indifference which, we think, was common in such cases, desired 
us to take charge of some pecuniary concerns of his. His 
sufferings were heart-rending, we were informed, for more than 
an hour after we saw him, when he quietly expired. From what 
we have since seen, we feel confident that if we had seen this 
patient a short time after the attack he might have been saved; 
his bowels were not acted on during the night ; he had diar- 
rhoea during the preceding day, but not such as to alarm 
him, or to interrupt his business. But, the strength which 
enabled him to walk home after the fatigue of the day, leaves 
room for the belief that he was then in a situation to be 
saved by bloodletting, to such extent as might have been neces- 
sary to relieve the spasms and brighten the color of the blood ; 
which last we had seen in several cases. With a view of sub- 
stantiating such an opinion, we shall detail a few other cases 
apparently similar, which yielded to that remedy. We did not 
bleed L. G. Wells. 



BLOODLETTING IN SPASMODIC CHOLERA. 

Our attention was called one morning, by a gentleman in 
the street, to the case of a colored man suffering the most 



152 EPIDEMIC CHOLERA. 

agonizing cramps. We found a stout, muscular man rolling 
over the pavement, with his mouth wide open, his limbs con- 
torted, his pulse very tense, but slow, and his groans and 
shrieks were heart-rending, and had attracted a large crowd of 
people around him. He had not been drinking. The salt- 
water emetic being then in vogue, we speedily procured a pint 
bowlful of strong warm saltwater, and he drank it all willingly. 
We waited several minutes to see the effect ; it had no effect 
whatever, and he continued to toss and moan as much as ever. 
Finding that he was not likely to vomit, we procured the neces- 
sary means, and bled him on the pavement, believing that, if 
we waited to get him to the hospital, would be to wait till too 
late. When we had obtained about thirty ounces, we perceived 
there was a slight change in the color of the blood; it was ex- 
tremely dark and thick at first. The patient now observed 
that the pain had abated in his stomach ; directly again, he 
said his stomach was entirely relieved of the pain, but it was 
very bad in his back. When about thirty-six ounces had been 
drawn, he remarked that he was entirely free from pain ; but 
he was sick. The blood was now most obviously changed to a 
much more florid appearance. Being in a hurry, we now left 
our patient, and desired a boy, who was in waiting, to take 
him in his hospital-carriage and carry him to No. 1, so soon as 
his faintness passed off. Dr. Charles S. Davis was present, 
and agreed with us that there was about thirty-six ounces of 
blood. Soon after we left him, an attempt was made to take 
him to the hospital, but he refused to go, and a controversy 
rose up among the people, some insisting upon his going to the 
hospital, and others declared he should not be taken without 
his consent. While they were disputing, he arose amid the 
crowd, and flung his arms about as he walked off; in this way 
he set his arm to bleeding, and, it was said, he bled freely. 
He reached his stopping-place, his wife being a slave, some 
squares off; he soon regained good health without any medical 
aid. These facts were reported to us by a respectable friend, 
who felt an interest in the case, and saw the man at home ; we 
think, however, that the dose of salt-water which he took would 
purge him, and this might aid the bleeding; and thus was he 



BLOODLETTING IN SPASMODIC CHOLERA. 153 

relieved from a situation of great peril. If we may be allowed 
to give an opinion, after having seen much of the disease, we 
say, it was a decided case of cholera, and a few minutes delay 
would have proved fatal. The cholera prevailing extensively, 
and the undisguised suffering, and exceedingly violent cramps 
and convulsive contortions of the limbs, shows this to have 
been real cholera. The first drawn blood was very dark and 
thick, but by flowing freely it became florid. 

During the height of cholera, we were called to see a young 
lady, who was said to be violently ill ; upon our arrival, we 
found she had been taken suddenly ill; she had the most 
agonizing spasms, and required of her friends that they should 
rub her constantly and briskly ; her skin was cold ; her pulse 
sluggish and tense ; unable to stand ; tongue moderately coated 
yellow- whitish ; countenance exhibited great distress and pros- 
tration, and there was an extraordinary degree of a feeling of 
sinking. We found Professor Potter with this patient, who 
asked us to confer with him, both of us having been sent for in 
the absence of the family physician. He was in the act of 
bleeding her, of which we approved, and we remained to see 
the effect. The blood was very dark; but, after a copious 
bleeding, the blood became of a lighter color, and the spasms 
of the stomach and extremities ceased ; the pulse became softer 
and more free and frequent in its action ; her respiration and ex- 
pression much improved. Aware that this was a case of violent 
disease, and that the truce gained by the bleeding would be of 
short duration unless other remedies were employed, we re- 
marked that we had some pills, containing 9j. calomel and ij. 
grains of opium each ; the Doctor replied that that was the 
very remedy he wanted, and we gave her one of them (these pills 
were only given on extraordinary occasions). In about three 
hours we found the patient in violent spasms, which were 
general, and we were told, that soon after we left the patient, 
she was so much better, that she was allowed to walk up stairs, 
having been, the first time, seized in the sitting-room below. 
We ascribed the return of the spasms to the walking up stairs 
soon after a copious bloodletting. We left the house under an 
impression that she would not survive the night ; but she rallied, 



154 EPIDEMIC CHOLERA. 

and in a few days was restored to health. We are decidedly 
of the opinion that this young lady owed her life to a copious 
and timely bleeding, followed by a full dose of calomel and 
opium, and this followed, no doubt, by judicious treatment by 
the family physician. 

About the same time of the occurrence of the above case, we 
were called to the case of another young lady of delicate health, 
who was suddenly overtaken with feelings of prostration, and 
strong sensations of syncope ; severe cramps of the stomach ; cold 
skin ; countenance greatly anxious ; respiration a good deal la- 
borious ; tongue slightly coated ; pulse full or voluminous, with 
but little action. We never felt ourselves placed in more 
onerous responsibility. We had seen some patients speedily 
sink from the loss of a few ounces of blood ; we had seen others 
in whom we had every reason to believe that death, which 
seemed to be near at hand, was warded off, and recovery ob- 
tained, by a copious bleeding. We tied up the arm, deter- 
mined, as much as we could, to appreciate the effects of the 
bleeding as we proceeded. We soon, to our inexpressible joy, 
found that the pulse was improved, and the feelings of the pa- 
tient rallying for the better; and in this case, as in many 
others, we were enabled to assure her that the danger wa3 over; 
for we saw here, as in other cases in which the pulse reacted 
promptly, that the blood became redder, and the oppressed con- 
dition was relieved, and we had remarked that wherever bleed- 
ing seemed to act prejudicially the patient sunk speedily. In 
our own practice we had seen two cases in which bleeding was, 
perhaps, used too late in persons of vicious habits, and we saw 
several others in the course of the season wherein this circum- 
stance was too manifest to admit of a doubt. This remarkable 
difference in the result of bleeding is sometimes to be seen in 
other diseases ; but we think in none so frequently as in cholera. 
This will always be perplexing in cholera, since no positive 
rule can be laid down. The only general rule which we were 
enabled to lay down for our governance, was to apply blood- 
letting in cholera as we would in cases of hemorrhage from the 
lungs or stomach, particularly from the lungs. The patient 
that is as pale as death from pulmonary hemorrhage, may 



BLOODLETTING IN SPASMODIC CHOLERA. 155 

sometimes be relieved by the abstraction of blood from the 
arm ; in these cases there may be great muscular prostration, 
and cold surface, and yet the pulse exhibits some tolerable 
force, and we may be justified in drawing blood, which we know 
from experience will arrest the hemorrhage from the lungs. 
We need not stop to explain how it operates, it is enough to 
know the fact, and that however safe and salutary may be 
bleeding under proper circumstances, yet, if the heart and ar- 
teries are actually reduced below par, we cannot expect the san- 
guiferous system to react by abstracting blood, as we know we 
may in common cases in which there has not been too much 
direct exhaustion. So in cholera, while there is a certain 
amount of force or strength in the system, and the blood is 
found to be very dark, but ready to flow freely from a good 
orifice, we may venture to bleed; and, if skilfully applied, the 
result will generally be favorable, and afford oftentimes speedy 
relief, and in greater degree than we have seen in any other 
disease. 

We have to state, that in nearly all the cases in which we 
saw very clearly marked benefit from bleeding, the rice-water 
evacuations were not a prominent symptom ; there was in 
almost all cases of the epidemic more or less diarrhoea, but 
mostly not such as to excite much alarm. But many cases oc- 
curred where, after diarrhoea, spasms or cramps, cold skin, and 
great distress about the prsecordia, a sudden change would take 
place of vastly increased violence of the cramps in the stomach 
and bowels, &c, accompanied with, or followed by copious 
rice-water discharges. We saw one of exceedingly violent 
spasms of the face. The same rule was followed here as in 
other cases in the use of the lancet, i. e., bleed as we would for 
arresting hemorrhage ; suddenly lessen the force of the heart 
and arteries by abstracting blood while these structures are op- 
pressed by over-excitement, and you thus arrest the morbid 
and overwhelming excitement present ; but bleed after the vital 
forces are exhausted by the wasting of the serum of the blood, 
or the blood itself, and you can never cause the vessels to re- 
act, but by abstracting the vital fluids, already too small, your 
patient is irrecoverably exhausted and lost. 



156 EPIDEMIC CHOLERA. 

One of the most important circumstances connected with 
bleeding in cholera is this : whatever be the nature of the case 
requiring bloodletting, the period in which it can be beneficially 
applied is very short ; we think a few minutes will make the 
difference for good or evil of the remedy in some few cases. 

It has been supposed that in cases attended with wasting 
serous discharges, bleeding cannot be practised with prospect of 
success, because the rice-water discharges consist principally of 
the serum of the blood. It was this circumstance that led us to a 
correct view, as we hope, of the employment of bloodletting. 
If we see the blood pouring from the lungs, and our patient 
pale and apparently sinking, we know, by experience, that for 
a time, or until a certain amount of blood has been lost, we 
may arrest the further flow of it by abstracting a portion from 
the arm (see Cullen), and thus check a fatal tendency in the 
disease; so in cholera, a portion of the blood is passing off 
rapidly — divert the morbid action, which is, so to speak, pushing 
the blood or serum out through the exhalents of the bowels and 
the skin — you may thereby prevent the further escape of the 
fluids, and, as has been correctly said, sometimes it is better to 
bleed from the arm than that the blood should flow away in 
torrents through wrong channels. 

In the course of the epidemic season, we had many opportu- 
nities for observing that, notwithstanding there was a good deal 
of febrile action in some cases, and that in all our dissections 
there was a turgid state of the vessels of the mucous coat of 
the stomach and bowels, and of the brain, still, we have never 
seen opium so generally admissible during the presence of 
symptoms which seemed to forbid its use. It was in the early 
period of the disease, however, that we observed the most de- 
cided effects from large doses of opium, and under such cir- 
cumstances, to give it in small doses, to say the least, was 



We never saw a disease in which any remedy came so near 
the nature of a specific as did opium in the incipiency of 
cholera ; for, according to our observation, it was suited to the 
disease in every form or stage attended with severity, and in 
scores of cases we have had the most pleasing effects from 



BLOODLETTING IN SPASMODIC CHOLERA. 157 

large anodynes, particularly when opium was given in combi- 
nation with calomel. So often did we obtain benefit from large 
doses of calomel and opium, that we gave it in many unpro- 
mising cases at the commencement with a degree of confidence 
little short of certainty ; indeed, we may truly aver, that this 
combination did not fail to give relief, except in two or three 
instances in private practice, some of which we saw a little 
short of profound collapse. We met but a single case which 
ended fatally, where we had hope of recovery at our first visit. 

We are too imperfectly acquainted with the pathology of 
cholera to attempt an explanation of the modus operandi of 
opium, but our experience with the article convinces us that, 
in combination with calomel, it had a powerful effect in check- 
ing rice-water stools, in allaying the irritability of the stomach, 
and in arresting cramps and spasms. When these symptoms 
set in violently and suddenly, it was safest to conjoin blood- 
letting with the opium and calomel. We saw one case of 
cholera in which the rice-water discharges were succeeded by 
complete ileus, attended by vomiting of dark, fecal matter in 
large quantities. In this case an emetic of strong salt water, 
followed by three grains of opium, in one dose, at once arrested 
the ileus, and the patient recovered in a few days. 

We seldom gave more than one dose of opium ; sometimes 
we repeated once. In a few cases it was given in small doses, 
in the form of Dover's powder, or laudanum and sp. of nitre, 
mostly where the spasms were rather obstinate than severe. 

There was an unusual circumstance attending the use of 
opium in the cholera of 1832. In no case where it failed to 
afford relief, did it deceive by giving ease. If a full anodyne 
failed to give pretty prompt relief, the patient always perished ; 
but when the patient was promptly relieved by the use of 
calomel and opium, they always recovered. We did not in any 
instance give more than six grains in twenty-four hours, and 
that quantity very seldom. This announcement was published 
in our Journal in 1832 ; since then, in a few cases, we have 
given as much as twelve grains in twenty-four hours, frequently 
eight grains, and we never had reason to believe we gave too 
much ; but these are exceptions to a general practice. 



158 EPIDEMIC CHOLEKA. 



REMARKS ON LOCAL BLEEDING. 

Local bleeding has been a good deal employed, by leeching 
and cupping. The employment of these means must be at- 
tended with much inconvenience in time of an epidemic, owing 
to the time that is required for their employment ; but inde- 
pendently of this, we never saw any clear indication for their 
adoption, and where these means were used, we never were 
sensible of any benefit being derived from the practice. The 
congestion of the vessels of the mucous lining is by no means 
inflammation. According to our observation, where sanguineous 
depletion was necessary, it was required promptly and copiously. 
This remark, however, applies to a real choleraic stage, or in 
the period or condition in which danger arises from a tendency 
to decomposition in the blood ; and as a preventive or cor- 
rective for this tendency, we believe no dependence what- 
ever can be placed on local bleeding. When this stage shall 
have given place to a more ordinary febrile action, and bilious 
symptoms, this remedy is no longer necessary. If there be 
any exceptions to this remark, they are very few. Now and 
then phrenitis supervenes upon the more ordinary symptoms of 
cholera. In such cases, local bleeding seems to be indicated ; 
but as far as we observed, we never saw any positive indication 
for the remedy. In cases of great prostration, blistering the 
neck may be beneficial, and the use of Dover's powders some- 
times had a good effect. We saw one case in which, after 
a severe attack of cholera, so soon as a state resembling con- 
valescence appeared, the patient had symptoms of mania a potu, 
and had to be subjected to the strait jacket. He was bled 
from the arm with a most happy effect, and bleeding was re- 
peated, to the relief and recovery of the patient. 

However little we may know of the pathology of cholera, it 
is evident that one of the common effects of the poison is to 
impair the functions of the stomach, bowels, liver, and, indeed, 
all the abdominal viscera ; so much so, that in many cases, long 
before the disease assumed its malignant form amongst us, in 
1832, most persons were aware of some impairment in their 



REMARKS ON EXTERNAL HEAT IN CHOLERA. 159 

digestive organs ; and hence it was, that one of the greatest 
difficulties attending cholera was to get our patients in a con- 
dition to bear food. In a great majority of severe cases, 
the digestive functions were much weakened, and it was 
with extreme difficulty patients could resume the use of the 
mildest articles of food. We had often seen injury arising 
from the use of improper food in bilious and other fevers, but 
never did we see anything bearing any comparison with this 
circumstance, as it stood related to cholera. At both hospitals, 
patients injured themselves in that way, in despite of all pre- 
cautions, and some of them died from their imprudence. . In 
many instances, nothing but gruel, sago, toast-water, common 
tea, or other drinks equally mild, could be borne for upwards 
of a week, although convalescence progressed slowly ; and 
often, in private practice, we had considerable trouble in 
getting our patients to resume their accustomed food, owing to 
liability to diarrhoea and pain in the stomach. 



REMARKS ON EXTERNAL HEAT IN CHOLERA. 

So soon as we saw the disease in its malignant stage, and 
beheld the shrivelled, hardened, and cold state of the skin, and 
this attended mostly with cold, clammy exudation through the 
skin, we were led to expect much benefit from the application 
of 'dry heat, and stimulants externally applied. We soon 
found the regular and effectual application of heat to the sur- 
face almost impossible ; and, sft^far as we could discern, no good 
was derived from it in most instances, if in any. Nor was it 
long before we were led to believe, that no benefit from the use 
of stimulants to the surface, except sinapisms to the stomach, 
and blisters, with a view of relieving that point from pain or 
distress, were useful. As far as we could judge, we never saw 
external stimulants useful in overcoming a dangerous amount 
of coldness of the skin or extremities, nor did they ever im- 
prove the vascular action of the skin, or relax or soften it, 



160 EPIDEMIC CHOLERA. 

raise its temperature, lessen the exudation, or impart a more 
agreeable state of feeling to the sick. Such being our con- 
viction early in the disease, we entirely discontinued the use of 
external heat and stimulants, so far as any supposed influence 
they might have in arresting the disease by operating through 
the skin, upon vital internal organs. 



THE EXTERNAL USE OF LARD IN CHOLERA. 

To us, it would seem to be as reasonable to expect to apply 
remedies to the knee for the relief of hip disease, as to expect to 
cure cholera by remedies applied to the surface. It does not 
seem reasonable, when we look at the deeply diseased state of 
the skin, that we can operate sufficiently through it upon the 
internal organs; it is enough to expect of this important 
structure, that it can be relieved of its own share of the disease 
by means applied to it. But as much evil grows out of the 
escape of serum through the cutis vera, and diminished supply 
of blood in the capillaries, it is important that we counteract 
this morbid condition. Seeing the good effect of oily applica- 
tions in erysipelas and phlegmasia dolens, and also recollecting 
that Dr. Scott, about fifty years ago, employed olive oil with 
good effects in a severe fever, somewhere in the East Indies, 
we were led to try it in the sweating state of epidemic cholera ; 
besides, in an ardent fever of a child, we applied Scott's method 
successfully. Hog's lard being a softening, oily substance, and 
this having been used by Dr. Calhoun, of Philadelphia, instead 
of mercurial ointment, which had been recommended by Dr. 
Little, of Pennsylvania, and the lard being cheap, and well 
suited to hospital practice, we introduced it into our Hospitals 
No. 1 and No. 2. It was soon seen that this article softened 
and warmed the skin in much greater degree than stimulants, 
and also lessened the exudation through the skin more effectu- 
ally than anything else. Indeed, in nearly all cases, with a 
few repetitions, it checked the perspiration, and improved the 



PRECAUTIONARY MEASURES IN PREVENTION OF CHOLERA. 161 

dermoid tissue in respect to temperature, pliability, and removal 
of wrinkling, and in all respects imparted a more healthful 
aspect to this structure. The gentlemen who had charge of 
the hospitals were well pleased with the results of this remedy. 
We now recommend it as a very important remedy. The late 
Professor Potter, having used this remedy, promised more 
than once to write in favor of it. 

This seems to be a proper place to state a case in which the 
application of the lard was attended with a very happy result. 
A professional friend had an attack of cholera, pretty early in 
the epidemic of 1832 ; it terminated in a tedious typhoid fever, 
that lasted some three or four weeks, and was attended with 
annoying and debilitating night sweats, which baffled every- 
thing that could be thought of. Sleep was greatly interrupted 
by cold, clammy perspiration, night after night. We directed 
a free and general friction with melted lard. It had the effect, 
by a single application, to restore the skin to its normal con- 
dition, and he rapidly regained good health. So prompt and 
grand an effect from any remediate agent did not occur in our 
practice during the cholera epidemic, except from the use of 
the lancet, in a few cases. This gentleman reminded us a few 
days ago of this occurrence. 



REMARKS ON PRECAUTIONARY MEASURES IN VIEW OF 
THE PREVENTION OF CHOLERA. 

We have alluded, in this work, to the well-known law of 
epidemics, that they partake of a revolutionary character. 
There are certain periods of indefinite intervals, in which epi- 
demic diseases appear and disappear, or change their nature 
from time to time, and appear with more or less force or 
peculiar modifications. We should, therefore, keep a watchful 
attention over our diseases from season to season, and endeavor 
to change our mode of living ; otherwise, we are liable to be 
overtaken by epidemic diseases, which generally come in dis- 
guise, and find us too often unprepared for the assault. In 
11 



162 EPIDEMIC CHOLERA. 

the late visitation (1832), the disease first appeared abroad, 
and gradually appeared nearer to us, and thus were we provi- 
dentially enabled to make preparation for its reception ; and 
this, no doubt, saved many who otherwise would have fallen 
victims to the pestilence. On some other occasion it may rise 
up among us when we are less prepared. 

It is hoped enough has been said respecting epidemic cholera 
to prove its non-contagiousness. In Baltimore such an opinion 
has been a source of considerable saving of expenditure for 
supposed measures of defence, which did no good, and much 
anxiety, disease, and death, arose from the prepossessions, 
among a portion of our citizens, that the disease was contagious, 
and the evil was greatly increased by some of our medical men 
declaring that the disease was contagious. 



EPIDEMIC CHOLERA THE PRODUCT OF A GENERAL ATMO- 
SPHERICAL CONTAMINATION. 

The astronomical observer may treasure up stores of know- 
ledge among celestial bodies, measure their orbits and their 
velocity, but what does he know of the intrinsic nature of the 
principle of gravitation, or of the magnetic attractions of the 
poles ? 

He may observe the several modifications of electricity, and 
guide it in subserviency to his wants ; but what does he know 
of its intrinsic nature ? Of this mighty power we shall have 
more to say as we proceed. He may observe the laws and 
visible effects of light, and unfold the boundless panorama, the 
offspring of light ; but what does he know of its incubation or 
its birth ? We might thus go on and remind those who inquire 
into the things of nature, that in the most exalted philosophical 
studies of man he collects visible phenomena for use ; but the 
grand principles are beyond the ken of finite mind. 

Need we wonder, then, if, while we behold the atmosphere 
as one of the greatest works of nature, we are not able to dis- 
cern but a part of its operations, except by their effects? One 



THE PRODUCT OF ATMOSPHERICAL CONTAMINATION. 163 

of the wonders which we observe in its character is the unifor- 
mity or sameness of its constitution; but, nevertheless, we dis- 
cern many changes and even vagaries occurring near the sur- 
face of the earth. 

In the beginning of this work we have alluded to the views 
of Dr. Sydenham respecting secrete constitutions of the atmo- 
sphere, by which he means a state of contamination that has 
the quality of generating disease, and he maintains that these 
secrete constitutions give rise to ailments of a specific nature, 
differing only in some modifications in their characteristics and 
force. 

We shall endeavor still further to illustrate the nature of 
the atmospherical insalubrious qualities. In the year 1817, 
we wrote out some essays, in the form of lectures, on the sub- 
ject of fevers, embracing all the fevers of which we were then 
cognizant. The cholera was not then known as one of the de- 
stroyers of the human race, and there may be those who would 
exclude it from among diseases called fevers ; but, we would 
ask, what else can it be ? It is the result of an imbibed poison 
which gives rise to a condition of the system, in which Syden- 
ham says, Nature, being oppressed, is unable to manifest the 
symptoms proper to the nature of the disease; and Rush would 
say, it is a misplaced fever, because the onus of the disease is 
not placed on those structures which, in more ordinary fevers, 
give rise to symptoms which we have long since known as the 
more pathognomonic signs of what may be termed genuine or 
true fever. 

We consider the opinion here expressed of the highest im- 
portance, seeing, as we think we do, much error and evil grow- 
ing out of a notion, which seems to prevail universally, that 
cholera is a subject the fit recipient of empirical practice. 
While we see the views of Rush prevailing everywhere where 
medicine is used as a science, we prescribe for the symptoms 
and stage of a disease, and not, as antecedently, for the name: 
in cholera the practice seems to have been almost entirely em- 
pirical. In every recurrence of epidemic cholera, practitioners, 
young and old, seem ever to be looking for specifics or nos- 
trums ; we might rather ask, what has not been tried than what 



164 EPIDEMIC CHOLERA. 

has been tried? We once knew an old practitioner, who took 
it into his head that there must be a specific or cure for yellow 
fever, and having the opportunity of seeing a good deal of the 
disease, he announced to the public, through newspapers, that 
he had gone the round of the Materia Medica, not omitting the 
most inert articles, such as prepared chalk, charcoal, &c, &c, 
the names of all which, amounting to hundreds, were an- 
nounced, but some one or more ; which were a sovereign cure 
for yellow fever, and this he cherished in his ^own bosom, for 
the world never found out what it was ; and so people died of 
yellow fever just as they always had done. And let me inquire, 
whether, so far as practice is concerned, the regular part of 
the profession have not pursued pretty much the same plan of 
procedure in the treatment of cholera? We shall, in proper 
place, endeavor to give some account of the multitudinous me- 
dicamenta that have been employed in cholera, and also throw 
out some hints descriptive of the mode which seems to be re- 
quired in the treatment of that epidemic, a strong point in 
which is to judge of each case as being peculiar : this will require 
a knowledge of the circumstances, symptoms, and the judicious 
adaptation of remedies to the ruling tendencies of the epidemic 
at that time. This, we opine, is the only way in which we can 
expect ever to treat the disease with better success than now 
obtains. In aiming at the accomplishment of all this, we must 
never lose sight of the important truth, that cholera is the 
offspring of a "secrete and inexplicable constitution of the 
atmosphere." 

We hope our readers will excuse our occasional digressions 
as we endeavor to present cholera to their notice under every 
possible aspect; while our main purpose is to reduce matters to 
greater order, or to systematize what we deem most important, 
we now and then bring to view vistas that now and again fall 
in our way ; in this way, we will be enabled occasionally to 
embody in our work reflections, observations, or remarks, that 
might otherwise escape annotation. Asking indulgence in this 
respect, we return to our observations on atmospherical con- 
stitutions, by which all epidemics are begotten and maintained. 

The illustrious Sydenham paid much attention to the subject 



THE PRODUCT OF ATMOSPHERICAL CONTAMINATION. 165 

of atmospherical constitutions, and thereby improved the prac- 
tice of physic in an eminent degree : he candidly acknowledges 
the difficulty and uncertainty of this branch of medical learn- 
ing: "If one were to examine all the branches of physic, no- 
thing would appear so surprising as the different and perfectly 
dissimilar face of epidemic diseases, which do not so much relate 
to and depend upon the various seasons of the year as upon 
the different constitutions of years." And again: "And this 
manifest diversity of these diseases still further appears, not 
only from the proper and peculiar symptoms, but also from the 
different methods of cure they respectively require. Hence, 
it is clear that these distempers, though to less accurate ob- 
servers they may seem to agree in their external face, and 
certain symptoms in common, are, in reality, of very different 
and dissimilar natures. 

" This I am certain of from numerous careful observations, 
that certain diseases, especially continued fevers, differ so ex- 
tremely, that the same method which cures in the middle of 
the year, may, possibly, prove destructive at the conclusion of 
it ; and when once I had happily fallen upon a genuine method 
of treating any species of fever suitable to its nature, I always 
proved successful (proper regard being had to the constitution, 
age, and other particular circumstances of the patient), till 
that species became extinct, and a new one arose, when I was 
again doubtful how to proceed, and, notwithstanding the ut- 
most caution, could scarce ever preserve one or two of my first 
patients from danger till I had thoroughly investigated the 
nature of the distemper, and then I proceeded in a direct and 
safer way to the cure." A more important medical truth was 
never recorded than what is here set forth, and it is necessary 
to be observed and adopted into use as far as possible in epi- 
demic cholera; and although we may never reach the goal of 
our expectations in this respect, certain it is that this is the 
right road to the high point of which we are in pursuit, while 
intent upon rearing an edifice, wherein to imprison and chain 
fast the monster which scatters desolation over every land, 
and at this time over every clime. 

It seems to us proper, under the present head, to offer a few 



166 EPIDEMIC CHOLERA. 

remarks upon causes, since it is our present purpose to show, 
as far as our abilities will enable us to show, that cholera is 
the offspring of malaria, and of nothing else ; but it is of a 
dual character, and we must endeavor to show how that ma- 
laria operates upon the human body as a cause. The various 
causes, which have been spoken of by medical writers, may be 
referred to the following: 1. Antecedent or predisposing cause. 
2. The remote cause. 3. The occasional or exciting cause. 
4. The proximate cause, according to the books; but cholera is 
characterized by duality of its cause — of this hereafter. 

A great proportion of our diseases arise from specific causes, 
and such causes always give rise to specific diseases, and this 
truth is especially manifested in epidemic cholera ; but it is 
difficult to distinguish a specific cause sometimes from suscepti- 
bility. And, we think, this applies to cholera, which is the 
offspring of a compound cause. There is at the present time, 
and, indeed, for several years past there has been, a pestilen- 
tial condition of the air, wide-spread as the inhabited world, 
which operates in the production of a susceptibility to cholera, 
which, of course, impairs the system perniciously. We sup- 
pose that the peculiar morbific principle, which leads to tha u 
disease, is brought into play by some chemical union with what- 
ever established that perniciousness; and this, so far as the 
epidemic operations are involved, seems to be a modification of 
the ordinary miasm, which gives rise to remittent and intermit- 
tent fevers, that is, this poison is probably formed of the usual 
elements differently combined, so as materially to alter the 
properties of the miasmatic poison. It may be said here, that 
this is mere matter of opinion; but how shall we more ration- 
ally apply the facts connected with the production of universal 
cholera ; for we are certain there must be some material which 
exerts a baneful influence over a large portion of the world ; 
well, then, where is it ? can it be anywhere but in the lower 
stratum of the atmosphere? Then, as to the special locations, 
we see the disease existing almost exclusively in fever districts ; 
what can it be, seeing that it is seen in many places usurping 
the place of fever, which heretofore prevailed, more or less, 



THE PRODUCT OF ATMOSPHERICAL CONTAMINATION. 167 

till cholera assumed the mastery, and principally in the fever 
season. 

We sometimes see sporadic cases of cholera. We see the 
same thing of yellow fever. Yellow fever, however, is always 
limited to narrow space, and, so far as we recollect, never was 
more extended than it was in Philadelphia in 1793 ; but cholera 
is so wide-spread, and has had so protracted an existence, as 
to establish incontestably the fact, that the air we breathe is its 
abiding-place. This state of things keeps up a peculiar sus- 
ceptibility in the human system, from which, we believe, that 
almost any violence or disturbance of the healthy economy may 
give rise to cholera ; but no one, who has not been under a 
choleraic influence, has ever had the disease. It may be ad- 
mitted, however, that the system being impressed with the 
choleraic susceptibility, that impression may not wear out imme- 
diately upon an individual leaving the dual choleraic atmosphere ; 
but in the present day of the choleraic perniciousness, it is im- 
possible to get rid of it, and it follows that there is liability to 
cholera everywhere, but in the slightest imaginable degree, 
except where it usurps the power of ordinary miasm, and, in 
these locations, it almost never remains more than a few weeks 
in its malignant character, sometimes only a few days. Is it 
not a fair inference that there is, so to speak, one great mor- 
bific influence, for some time past, which has become an inte- 
gral of the atmosphere everywhere ; but it is only in certain 
malarious locations that the choleraic influence becomes dual- 
ized, and is stirred into its deadly assaults ; and do we not find 
here that two things, in the nature of causes, are present ? the 
one general and the other local. The former at present is in- 
scrutable; the other, it is said, has. become tangible only so far 
as we see it domiciliated in certain districts. One thing is be- 
yond all doubt or question, and that is, whatever may be the 
predisponent cause of cholera, it is evidently different from 
anything which was known in Europe or the United States 
until about 1830, '31 or '32. Are we, then, not bound to con- 
clude that this is a new thing, and there are cogent reasons for 
believing that the sun and electricity, if not the parents, do 
exert a primordial agency in the production of the new poison, 



168 EPIDEMIC CHOLERA. 

which may be by direct or immediate influence, or by co-ope- 
ration with new material arising from the face of the ground ; 
but where shall we find a guide ? so far, we have had none but 
blind guides. Something there is, but of its origin, or of its 
intrinsic nature, we are ignorant ; but its outward character is 
known, and, like the whirlwind, it rides unseen in the storm. 

Attempts have been made to trace the spread of epidemic 
cholera westward for two or three years past, by means of con- 
tagion, but we do not see how such an opinion can be enter- 
tained after the great number of reports of its occurrence epi- 
demically in all countries, showing that, with few exceptions, 
it has been preceded by an insalubrious atmosphere, which gave 
rise to disorders differing from cholera only in being milder; 
and, again, in many different cities it has spread so rapidly 
through many streets in a few days; indeed, we might say 
truly, the cholera, when it assumes the malignant stage, is 
always in a hurry. In many towns, and in some country lo- 
cations, it is like the alighting of some evil genius, — it smites a 
few victims, then, with seeming satiety, seeks other victims in 
other places. 

In Hamburg, it appeared in upwards of one hundred streets 
in four weeks, and yet the mortality was moderate, considering 
the deadly nature of the malady during "its reign of terror," 
which, thank Heaven, is always brief compared to small-pox 
and some other diseases, which linger year after year in large 
cities, through all seasons of the year. We purpose devoting 
a section of this work to the question of contagion, and there- 
fore forbear making any further remarks in this place. 



ELECTRICITY AS RELATED TO CHOLERAIC AFFECTIONS. 

It seems proper that we call the attention of the reader, for 
a few minutes, to attempts that have been made to show that 
certain phenomena connected with the atmosphere are the 
cause of epidemic diseases; there have been advocates for the 
opinion that electricity is one of the agencies in the production 



OBSERVATIONS ON SUMMER AND AUTUMNAL DISEASES. 169 

of disease. This grand principle invades all space, and is, 
truly, protean in its nature, and is, in many respects, a con- 
trolling power over created things in every department; but 
has, and is likely to continue to elude all our inquiries respect- 
ing its influence upon the diseases of the human body. That 
it bears an important relation to the causes of our diseases, and 
upon the diseases also, is manifest. If we look at the beauti- 
ful plumage of the bird tribes, or the gaudy butterfly, and the 
flowers of every clime, and believe that every tint and every 
form are the rich productions of electricity, we might be led to 
believe that it has an agency in whatever concerns our welfare, 
and no less in the causes of our diseases ; but, admit this opi- 
nion, and we are no wiser as regards the intrinsic nature of the 
causes of epidemics or other diseases; we may, therefore, dis- 
miss this point of our subject as beyond our scrutiny and our 
comprehension; but we shall hereafter examine some new 
views of Schonbein. Attempts have been made to show an in- 
fluence over disease by lunar and sol-lunar influences, in which 
Dr. Mead took a conspicuous part ; the animalcular theory has 
also had its blind guides. . / 



SUMMER AND AUTUMNAL DISEASES, WITH OBSERVATIONS. 

This seems to be a suitable place for introducing the sub- 
ject of prevention ; by observations, &c, on causes immediately 
and obviously productive of our diseases of the summer and 
autumn ; the more so, on account of the cholera reigning, al- 
most always, in places annually subject to bilious fevers. This 
condition of things prevails so manifestly, that we may, there- 
fore, assume the position, that the causes of these diseases are 
nearly similar ; and on this ground we proceed to review some 
observations, and to inquire into the subject of the causes, and 
the means of prevention, of summer and autumnal fevers, by 
Rush ; for whatever will counteract the influence of miasm, as 
related to bilious diseases, will have some influence in the pre- 
vention of epidemic cholera ; differing, however, in this : the 



170 EPIDEMIC CHOLERA. 

poison, producing common fevers, acts as a specific cause, wliile 
in cholera it is only an additamentum dualis to an atmosphe- 
rical deleteriousness. 

"We find that our illustrious countryman, Rush, has left some 
facts and reflections upon this important subject, on which we 
shall now offer some comments, and abridge what he has said, 
which, to us, shall seem proper and useful, without the formality 
of quoting exactly what he has said, giving, however, nothing 
to alter his meaning without saying so. 

Dr. Rush first refers us to exhalations from marshes which 
give rise to miasm, which, he says, is supposed to be the pro- 
duct of a mixture of vegetable and animal matter. He then 
goes on to give a 'list of many vegetables, which, in heaps of 
more or less bulk, have been known to be the cause of bilious 
diseases. We deem it unnecessary to follow out these details ; 
some instances in a small way may be erroneous, but as to 
their general deleteriousness, there is no doubt. We will here 
briefly narrate a remarkable case which came under our own 
notice. At a time that yellow fever prevailed epidemically in 
Baltimore, five gentlemen occupied what was called the old 
Exchange, as an auction store and office. They all were seized 
by the fever within a few days — four of the five died. The 
Board of Health, being called to the premises, found the cellar 
under the office in a most filthy condition — potatoes, onions, 
and other articles were there in a state of putrefaction. These 
were removed, the cellar limed, &c, and the evil seemed to be 
arrested. The business of the house was of course broken up, 
but the disease did not spread across the street, which at that 
point was upwards of one hundred feet in width, but not much 
more. During the time of the attack of those below, there lived 
a poor man and his wife, with several children, in good health, 
but they did not use the same front door, but went out and in 
on another street, and did not occupy any part down stairs. 
Is there not very good reason to believe, that had the epidemic 
cholera been prevalent at that time, that those gentlemen who 
fell victims to yellow fever would have been destroyed by cho- 
lera ? 

The author before us enumerates among things likely to pro- 



OBSERVATIONS ON SUMMER AND AUTUMNAL DISEASES. 171 

duce summer and autumnal disease, the contents of privies, and 
tells us that privies are sometimes the origin of dysentery and 
diarrhoea, and he says, that during the American war, an Ame- 
rican regiment, consisting of 600 men, were affected with dys- 
entery, from being encamped near a large mass of human 
feces, and that the disease soon was checked by removing their 
encampment to a distance from it. We were once cognizant 
of dysentery being occasioned by exposure to the same sort of 
filth. A privy which had served the purposes of a pretty ex- 
tensive hotel, in an inland town, without being cleaned out for 
many years, was emptied in the summer season. A most ter- 
rible stench was produced in one of the streets, by scattering 
a good deal of the contents of the privy ; in a few days, several 
families were affected with severe dysentery, while no cases 
occurred in any of the other streets. 

Dr. Gordon informed me, says Dr. Rush, that 500 persons 
died of the yellow fever in Berbice, between July, 1804, and 
May,1805, during which time there fell but three inches of rain. 
The earth in this case was very dry and parched. Bilious 
fevers, Sir John Pringle tells us, occur in a part of Holland in 
very dry seasons, but in these cases the earth cracks, and 
putrid exhalations escape from water which stagnates below 
the surface. We are not always able to explain these apparent 
anomalies, but when the matter is established, that certain 
material is the source of malaria of a peculiar kind, there is 
scarcely room for doubt, that that kind of malaria can only 
arise from the same condition of things, though all may not be 
apparent — specific causes can only arise from the same pro- 
duct in all cases. 

Dr. Bush, after noticing the several diseases of summer and 
autumn, says : the means of preventing the different forms of 
fever that have been mentioned, come next to our consideration. 
Happily for mankind, heaven has kindly sent certain pre- 
monitory signs of most of them. These signs appear, 1st. Ex- 
ternally, in certain changes in the previous diseases, in the 
atmosphere, and in the animal and vegetable creation. 2d. In 
the human body. The first external sign that I shall mention 
is, an unusual violence in the diseases of the previous year or 



172 EPIDEMIC CHOLERA.^ 

season. Many proofs of the truth of this remark are to be 
met with in the works of Dr. Sydenham. It has been con- 
firmed in Philadelphia in nearly all the malignant fevers since 
the year 1793. But there is an exception to this remark, for 
we now and then observe uncommon and general healthiness 
before the appearance of a malignant epidemic. This was the 
case in Philadelphia previous to the fevers of 1798 and 1799. 

The author before us thinks that substances painted with 
white lead, and exposed to the air, suddenly assuming a dark 
color (the ozonometer will indicate impurity) ; and winds from 
unusual quarters, and unusual and long protracted calms, in- 
dicate the approach of a pestilential disease. The south winds 
have blown upon the city of Philadelphia ever since 1793, more 
constantly than in former years. Malignant and mortal epi- 
demics are often preceded by uncommon sickness and mor- 
tality among certain birds and beasts. They have both ap- 
peared, chiefly among wild pigeons and cats, in the United 
States. The mortality among cats, previous to the appearance 
of epidemics, has been taken notice of in other countries. Dr. 
"Willan says it occurred in the city of London, between the 
20th of March and the 20th of April, in the year 1797, before 
a sickly season, and Dr. Beniecia says it preceded a mortal 
epidemic in Paris. 

The common house-fly had nearly disappeared from our 
cities, mosquitoes have been multiplied, and several new in- 
sects have appeared just before the prevalence of some of our 
late malignant epidemics. Among things indicating an altered 
atmosphere, Rush mentions a knotty and imperfect state of our 
fruits, and that condition has preceded some of our epidemics. 
Besides those above, our author enumerates several other oc- 
currences, which seem to have some relation to the atmosphere, 
as regards its influence upon diseases. Our object here is to 
awaken public attention, as well that of our municipal officers, 
as that of our faculty, and the citizens at large. 



MEANS TO PREVENT THE SPREAD OF OUR EPIDEMICS. 173 



MEANS THAT ARE SUITED TO PREVENT THE SPREAD OP 
OUR EPIDEMICS, IN THE FORM OF SUMMER AND AU- 
TUMNAL DISEASES. 

We have elsewhere remarked, that epidemic cholera is seen 
to occupy locations where summer fevers . usually appear, and 
it will follow, that as the cholera comes in almost all cases as 
a sort of substitute for summer fevers, the same precautions or 
preventives will apply to both. Dr. Rush speaks of such as 
are proper to protect individuals, such as are proper to defend 
whole communities from the disease, and such as are proper to 
exterminate it, by removing its cause. 

Where flight is practicable, says Rush, it should be resorted 
to in every case, to avoid an attack of malignant fever. The 
heights of Darby and Germantown have for many years 
afforded a safe retreat to a. number of the citizens of Philadelphia, 
from their late autumnal epidemics. We had a happy corrobo- 
ration of this truth in Baltimore, in the year 1821 and '22. 
Hundreds of the lower orders of the people were removed upon 
an outbreak of a very mortal yellow-fever epidemic, whereby 
several hundred lives were saved ; and all those who were able, 
as respected the means, were required by ordinance to remove, 
on notice from the Board of Health. The opinion just ad- 
vanced will require some qualification. Thus, in small towns, 
or neighborhoods of small extent, it will apply in all its force 
wherever the cholera appears with startling malignancy ; re- 
moval will be attended with the happiest results ; but in cities of 
great extent, it is of much less importance, because the disease 
is more diffused than in summer fevers. The former cannot be 
known precisely as to location in most cases, but fevers are 
more specially confined to limits which do not vary much, and, 
as regards yellow fever, varies but seldom. 

Dr. Rush mentions many things which were supposed to be 
preventive of malignant fevers ; many of these are cases of 
single occurrence, and therefore not to be relied on ; we there- 
fore pass over them, and proceed to notice a few others, but 
wish here to remark, no violent changes should be made in 



174 EPIDEMIC CHOLERA. 

any of the common affairs of life ; but where matters have 
been at fault, changes for special causes should be made gra- 
dually. The author before us says, all those citizens who used 
garlic and onions (freely, we suppose) escaped the yellow fever 
in 1793. We have thought proper to notice this important 
item, but what would be the result of it in choleraic seasons, 
we will not undertake to decide. These articles afford a mild 
stimulant article of food, and would probably maintain the 
system for a short period in less bulk than things generally in 
use. We were somewhere told, by Rush, that the highland 
shepherds of Scotland will pass the whole day upon a single 
onion. How far the people of Paris use these articles, we 
cannot say, but the French are reported to use them ex- 
tensively. We have been informed of the mortality from cho- 
lera at Paris at its first appearance there. So far as we re- 
collect, the mortality there was greater than it ever has been 
anywhere else, and it will be more or less so wherever active 
stimulants are relied on for the cure of " misplaced fever," and 
cholera is nothing else. 

Among the exciting causes which give rise to malignant 
fever, Dr. Rush puts down heat and cold as leading ones, and 
he says, while the former has excited the yellow fever in 
thousands, the latter has excited it in tens of thousands. It is 
not in the middle latitudes only that the cold awakens this dis- 
ease in the body. Dr. Mosely says it is a more frequent ex- 
citing cause of that, and of other diseases, in the island of 
Jamaica, than in any of the most temperate climates on the 
globe. It is this which renders cases of yellow fever, when 
epidemic in our cities, more numerous in the months of Sep- 
tember and October than in July and August. This being the 
case, the means of obviating the pernicious effects of cold are 
evident to every one ; we must dress warmer and sleep warmer, 
and fire, in sitting-rooms, will be useful upon sudden changes 
during a choleraic atmosphere, particularly in wet weather. 
Cholera mostly sets in in warm weather, say August and Sep- 
tember ; there are exceptions in the Middle States ; but even in 
August this precaution is important at times in some parts of 
this country. 



DISSECTIONS AT THE BALTIMORE CHOLERA HOSPITALS. 175 

Many persons found safety from the plague of 1665 by flying 
to ships which lay in the middle of the Thames, and, it is well 
known, no instance of yellow fever (says Rush) occurred in 
those Philadelphia families that confined themselves to ships in 
the middle of the river Delaware in the year 1793. The au- 
thor before us tells us that large fires have sometimes been 
made in cities to destroy the miasmata of pestilential diseases. 
They were obviously hurtful in the plague of London in the 
year 1665. Dr. Hodges, who relates this fact, says: "Heaven 
wept for the mistake of kindling these fires, and mercifully put 
them out with showers of rain." We deem it a duty to state 
that in the month of September, during a spell of unusually 
warm weather, and during the prevalence of a very malignant 
cholera, at Columbia, Pennsylvania, we found many very hot 
fires of large piles of stone coal, which obviously added to the 
heat of the air, and filled every space with a sulphurous smell. 
We at once objected, and we know not what influence our opi- 
nion may have had, but, on a second visit, these fires had been 
extinguished. We are not certain that much evil arose from 
those fires, since the principal mortality had occurred before 
they were in use ; but we could not reasonably suppose that 
fire within view would improve a choleraic disposition of the 
air, or be any better than the employment of it in epidemic 
bilious diseases. 



DISSECTIONS MADE AT THE BALTIMORE CHOLERA 
HOSPITALS. 

1. Dissection of the body of Aaron, a black man. The 
lungs were nearly natural ; heart flaccid, left ventricle empty ; 
in the right ventricle there was found a few drops of dark co- 
agulated blood ; liver pale; gall-bladder distended with green 
bile; stomach much congested and traces of black mottling: 
intestines congested; bladder contracted. 

2. Post-mortem. — A woman: heart flaccid and empty; liver 
pale ; gall-bladder distended with yellow bile ; stomach had a 



176 EPIDEMIC CHOLERA. 

quantity of rice-water matter in it ; some bile in the intestines, 
and the coats very much congested, and also that of the stomach; 
bladder contracted to the size of a walnut. 

3. Dissection. — A man. The lungs natural; heart more 
firm than previous cases ; some blood in both ventricles of a 
black color; liver not so pale as former ones; gall-bladder dis- 
tended with green bile; stomach very much congested with red- 
dish matters in it; intestines highly congested, and a little bile 
in them ; bladder contracted. 

4. Case of Dissection. — A male subject. The nails of the 
fingers and toes were purple ; the skin much corrugated ; the 
lungs somewhat congested ; in the heart a small quantity of 
dark liquid blood ; liver pale ; in the stomach there was a quan- 
tity of rice-water serum ; the intestines congested ; the kidneys 
natural in appearance ; no urine or urinous smell ; slight traces 
of black mottling. 

5. Post-mortem. — A man. This dissection discovered the 
inner coat of the stomach and intestines to be much congested, 
and also the brain. 

6. Dissection. — A woman. In this case the lungs were 
nearly natural ; in both ventricles of the heart there was found 
some very dark blood ; the liver not so pale as other bodies 
which had been examined ; the liver not very pale, a little 
blood in it; the gall-bladder distended; the stomach and intes- 
tines not as much congested as in other cases ; in the spleen 
there was some dark blood ; the bladder contracted to the size 
of a walnut. 

The foregoing dissections are copied from the hospital reports 
of Dr. Carrere, at Hospital No. 2, for 1832. 

We shall now proceed to present a few cases from Dr. Mac- 
kenzie, at Hospital No. 1, for 1832. 

1. Case was that of a colored man. In the stomach and in- 
testines, particularly the stomach, there were three large dark 
patches on the mucous coat resembling incipient gangrene; the 
liver pale; the gall-bladder was nearly full of dark-green bile; 
the heart contained a considerable quantity of thick black blood; 
the bladder was contracted to a very small size ; no urine in 
the pelves of the kidneys. 



DISSECTIONS AT HOSPITAL NO. 3, BALTIMORE. 177 

2. Case — the dissection of a male subject. The stomach and 
small intestines very much inflamed (we would say, injected); 
the liver pale, very much enlarged and soft ; the gall-bladder 
partly filled with dark-green bile; no urine in the pelves of the 
kidneys; bladder very much contracted ; nearly four ounces of 
water in the pericardium ; and a small quantity of black blood 
in the abdominal aorta. 

3. Case — dissection of a man subject. The mucous coat of 
the stomach and intestines were very much inflamed (injected, 
we suppose); the liver was paler than usual, and very large; 
the gall-bladder was distended with dark-green bile; the spleen 
quite small ; the bladder contracted to the size of a walnut. 

4. Post-mortem of a man. Mucous coat of the stomach and 
bowels very much inflamed (congested) throughout its whole 
extent; the gall-bladder nearly full of thick green bile; liver 
rather pale ; bladder much contracted ; black blood in the ab- 
dominal aorta. On opening the head, the veins of the dura 
mater were seen very much congested, and spots were inter- 
spersed through the substance of the cerebrum, and particu- 
larly in the cerebellum ; a small effusion of water at the base 
of the brain. We deem these dissections sufficient to show the 
prevailing cast of pathological changes, so far as is really ne- 
cessary for forming an opinion of the character of epidemic 
cholera as seen in Baltimore ; and, we opine, in the main, these 
will be the prevailing appearances after the death of those who 
died in all places, differing somewhat in the detail in different 
seasons and different locations. We have already mentioned 
that we had an Hospital No. 3 in Baltimore in the year 1832. 
The pathological appearances were somewhat different from 
those from Hospitals No. 1 and No. 2 ; we shall therefore pre- 
sent them to the reader, that we may afford all possible infor- 
mation on this momentous subject. 



DISSECTIONS AT HOSPITAL No. 3, BALTIMORE. 

It is somewhat singular that Dr. Warner has given but one 
case of dissection ; he offers it, however, as a specimen of seven- 
12 



178 EPIDEMIC CHOLERA. 

teen cases which he dissected, and he precedes the post-mor- 
tem by the following remarks: "The following post-mortem 
examination of fourteen cases illustrates the morbid phenomena 
presented in seventeen cases; some little variations, indicative 
of old diseases, were occasionally detected, but do not appear 
to modify the present abnormal state. Catharine Bull, colored, 
aged twenty ; post-mortem three hours after death; abdomen 
puffed up; the whole alimentary canal distended with flatus; 
the minute ramifications of the mesenteric veins distended with 
dark venous blood; mucous membrane of the jejunum, ileum, 
and great intestine, blanched, and containing a large quantity 
of rice-water fluid; mucous membrane of the duodenum softened 
in one spot, and considered, from the appearance of the sur- 
rounding parts, to be the result of an old intestinal affair; gas- 
tric mucous membrane blanched, with distinct congestion of the 
venous capillaries ; stomach half filled with a dirty, blackish 
fluid, resembling the scrapings of the gutter; the hepatic and 
gastric plexuses of the sympathetic nerves were exposed, to- 
gether with the splanchnic nerve, and presented a very unusual 
appearance, and at the same time so firm and hard as to re- 
semble fiddle-strings. The most delicate fibres required con- 
siderable force to break them. Lungs blanched; heart-sub- 
stance purple, and easily lacerated; the left ventricle filled with 
black grumous blood; the abdominal aorta, iliac, and all the 
large arteries filled with the same ; gall-bladder half filled with 
healthy bile, and ducts pervious ; urinary bladder firmly con- 
tracted, and mucous surface dry; not a drop of urine in the 
pelves of the kidneys, ureter, or bladder; when the ureter was 
pressed upon, a drop of yellow mucus was pressed out ; brain 
of a livid cast, referred to venous congestion." 

Believing, as we do, that the information obtained at Balti- 
more, in the epidemic of 1832, is important, as well on account 
of its amount, as in regard to the success and advantages of a 
cholera dispensary, we have thought proper to present all the 
circumstances connected with the visitation in view. So that 
we could not well pass over the reports from Hospital No. 3. 
There is a very remarkable discrepancy between the pathology 
of Dr. Warner and the gentlemen at Hospitals No. 1 and No. 



REVIEW OF DR. BERG'S REPORTS IN SWEDEN. 179 

2. We have, in copying Dr. Warner's report of his post- 
mortems, italicized what he says of blanching of the stomach 
and bowels ; for we do not recollect seeing anything of the sort 
by the Baltimore physicians, and very few elsewhere. If it 
were a single case, we might pass it over ; but it is a true 
specimen, according to our author, of seventeen cases. 

Our reflections lead us to believe that we can explain the 
anomalous feature seen in the morbid appearances just noticed. 
" The tinct. guaiac. was freely used, and in no instance with 
benefit, while the most melancholy consequences attended its 
administration in several cases. I would direct your attention 
particularly to this article, as it is the most prominent ingre- 
dient in a vile nostrum widely circulated through our city." 
We cannot see why this notice is taken of a "vile nostrum," 
or why it should have been used in hospital practice ; certain it 
is that the Board of Health had nothing to do with this article, 
neither did the consulting physician ever prescribe it or notice 
it. Our principal reason for noticing this article is to oifer, 
as our opinion, that the tinct. of guaiacum and the tincture of as- 
safoetida may have been the cause of the blanching of the mucous 
coat of the stomach and bowels, reported as constantly present 
in his post-mortems. Every one knows that these articles, 
when mixed with water, and of course on a wet surface, will 
give a milky whiteness, and if continued and repeated often for 
a day or two, we think would give the appearance of blanching, 
which no doubt would attend the use of vinegar, as we often 
see upon the lips of persons who have just been using it. 



REVIEW OF DR. BERG'S REPORTS IN SWEDEN. 

We have here an exceedingly well-written review of an able 
work, so far as the compilation is concerned ; but, we think, 
the more is the pity, that so much zeal and talent should have 
been employed to bring before the public erroneous views to 
raise doubts on the causes of cholera, and to conduct those who 
are not prepared to judge for themselves into a labyrinth dark 



180 EPIDEMIC CHOLERA. 

and destructive. This being honestly our opinion of the pro- 
duction before us, Ave shall endeavor to examine the reports of 
Dr. Berg, and we hope to show to the inexperienced, that 
however captivating these reports, they are not to be relied on. 
Too often views and theories are espoused, and zeal becomes a 
blind conductor to hot pursuers after the res fallacissima, by 
which are brought forth deceptive responses. 

The reviewer before us says : "We saw repeated instances 
where a previously healthy locality was infected by persons 
arriving from a distance, and from places where cholera then 
prevailed ; we found that these individuals were sometimes ap- 
parently in good health when they arrived, or, perhaps, they 
already exhibited the premonitory symptoms of the malady; 
we met with them laboring under the disease in low lodging- 
houses, from which the disorder spread to other inmates of the 
same house or room, and we traced the malady from these 
lodging-houses to other localities, which, in their turn, became 
focuses of infection in previously healthy districts." 

Let us admit all that is said in the above paragraph, and it 
proves nothing but the coincidence of the occurrences ; persons 
were seen to arrive at a certain place which was then healthy, 
but who had just come from a place where cholera prevailed. 
At some indefinite time, cholera shows itself in the new-comer 
in some "low lodging-house." Let us suppose such an arrival, 
and that, in a short time, the visitor is seized with cholera ; is 
it safe to conclude that there was any positive relation be- 
tween the arrival of the person and the cause of the disease ? 
Do we not see cholera, like some other epidemics, set in sud- 
denly — in Columbia there was apparent health one day, the 
next day twenty-four deaths — so far as malignant cases are con- 
cerned ? Are not the "low houses" and places the most com- 
mon abodes for cholera? May we not as fairly infer that the 
stranger is as likely to take the disease as others in low houses, 
or it is a mere coincidence as to time, with the outbreak of 
the disease, as that because he had been somewhere where the 
disease -prevailed, therefore he must have brought the fomes 
of the disease with him. It cannot be denied that one of the 
most strongly-marked characteristics of the epidemic cholera 



REVIEW OF DR. BERG'S REPORTS IN SWEDEN. 181 

is the prevalence of morbid derangement of the primary organs 
of digestion and nutrition. The atmosphere becomes a maga- 
zine of choleraic malaria. Individuals, living in this unwhole- 
some magazine, are liable, upon transgressing in any of the 
non-naturals, to be seized by the malady, — the stranger 
comes to such locality, and it is fair to maintain that the 
fatigue, the change of water, food, loss of rest, perhaps anxiety, 
will render him more liable than those persons who have not 
been subject to anything unusual. But again, allusion is pre- 
sently made by the reviewer to Travemunde and Lubec, said 
to have been infested by cholera, which was not prevailing at 
Malmo. It was found that when a stranger had sickened and 
died or recovered, in one of those "low lodging-houses," the 
"disorder spread to the other inmates of the same house or 
room, and we traced the malady from these lodging-houses to 
other localities." Mark, first, the loose phraseology, "the 
other inmates." Where were they, and how many? were they 
so numerous as to leave no necessity for greater precision ? 
But, judging from choleraic epidemics in extenso, have we not 
as good a reason for supposing that all the inmates, and not 
less the stranger, were affected by the same cause, seeing as, 
we think, has been abundantly evident, that cholera does not 
only infest the atmosphere, but does literally sometimes ride 
on the whirlwind; for the choleraic poison being eliminated is 
now an integrant of the air, and perhaps comes with the zephyr 
of early morning or night. Thus, it is acknowledged, we be- 
lieve, on all hands, that cholera can only prevail where there 
is malaria of some sort, and it is begging the question to say 
that because a person has come from an infected place, and he 
locates among persons in other locations, he has brought the 
disease, and yet we know the malady may be concocting, or in 
a state of incubation, in his new location. Seeing the poisoned 
inmates emerging from a location known to be favorable to the 
growth of cholera, who shall decide which of the parties first im- 
bibed the poison? for we have seen that while there was repose 
and quiet and a full share of health existing in a certain place, 
the wind rose like a sirocco, and in one night scattered the seeds 
of cholera in a few houses, to the destruction, in fifteen days, 



182 EPIDEMIC CHOLERA. 

of about one hundred and fifty individuals, who could not pos- 
sibly have been subjected to any of that ill-omened contagion 
that is said to come from one sick of cholera. We shall, in 
proper place, present to our readers such an instance as we 
have just noticed. 

In great epidemics, we sometimes see large families seized 
one after another, just as we see in cholera ; they are visited by 
neighbors; these, in their turn, are taken down in the same 
way, and it would be the easiest thing imaginable to trace cases 
from house to house, and, indeed, in years gone by, we have 
known persons to attempt to trace cases of intermittent and 
remittent fevers, just as contagionists of the present day at- 
tempt to trace epidemic cholera. 



REMARKABLE EPIDEMIC IN 1804. 

In the summer of 1804, a very extraordinary epidemic spread 
over the Middle States of our Union, which evidently was the 
product of things tangible. One of the most luxuriant springs 
and early summers in the vegetable kingdom was followed by 
hot dry weather later in the summer. Freshets of unusual 
magnitude piled the cut grasses of meadows over low lands, 
mixed with much alluvium ; and the rank weeds, everywhere 
abounding, were seen rotting to an extent beyond what had 
ever been seen before or since. The lower portion of the at- 
mosphere seemed to have undergone one universal ozonization. 
We have, in a former part of this work, alluded to the fact of 
there being so much blending of diseases, as exhibited by their 
symptoms, as to show that there is a necessity, in the investiga- 
tion of them, for selecting those that are most strongly marked 
as standards, with which we must compare vagarious cases, 
otherwise it will often appear that several diseases are prevail- 
ing at the same time, and this has often been done by part of 
the profession. 

We have a memorable instance of this in the yellow fever of 
1793 in Philadelphia. A large portion of the profession con- 



REMARKABLE EPIDEMIC IN 1804. 183 

tended that yellow fever then prevailing was the result of im- 
ported contagion, and altogether different, in its whole charac- 
ter, from the remitting and intermitting fevers then prevailing 
in the city, and requiring a special treatment, and hundreds, 
perhaps thousands, died from this cause, owing to its leading 
to mal apropos treatment; but when Dr. Rush introduced a 
treatment suited to miasmatic disease, the devastating plague 
succumbed, proving incontestably that there was one cause and 
one order of disease, however modified, in the family group. 

In the year 1854, yellow fever and cholera were seen to pre- 
vail together at New Orleans. The former disease is indigenous 
in that city, and, of course, its specific cause exists at certain 
seasons at all times in more or less force. But the choleraic 
constitution, or if more modernized, a new cycle of atmospheri- 
cal influence now prevails universally, and even this domicili- 
ated hydra (yellow fever) bows before the monarch of the new 
cycle of malarious rule. For this reason, with slight modifica- 
tion, the treatment in the late epidemic at New Orleans ought 
to have been suited mainly to the cure of cholera, — if, indeed, 
we had any reliable curatives : this we have in cholerine. 

This seeming digression will, we hope, be excused, since, if 
we are correct in our views, it will follow that if diseases of one 
order are thus diversified, the much-abused contagion is but a 
phantom, as relates to yellow fever epidemics, more purely 
miasmatic epidemics, or choleraic epidemics, and perhaps others; 
and we think it cannot be too much insisted on, among funda- 
mental truths, that it is not more clearly a truism that " dis- 
ease is ever a war with nature," than that morbific cycles 
always prevail to control our maladies, and, as the term im- 
ports, changes come, giving to our diseases now a sthenic, and 
anon the asthenic character, associated with morbid specialities. 
And, although shrouded in various sorts of disguise, yet are 
the phenomena manifested to a careful observer, sufficient to 
give light enough to lead us into pavilions where are to be found 
many responsive oracles, that will disclose to us knowledge 
which will lead us to a right understanding of specific diseases, 
which are generally epidemic, and direct us in an efficient 
treatment. 



184 EPIDEMIC CHOLERA. 

We think it truly important to enforce the opinion, that 
every specific disease, while it presents what we term standard 
cases, or cases that are 'pure in hind, in all epidemics there will 
be seen cases contemporaneous with maladies that are more or 
less variant from the true standard. Of the truth of this opi- 
nion, we have a striking instance in the miasmatic epidemic of 
1804. We have shown that the land was filled with the ma- 
terial which has long been supposed to produce remitting and 
intermitting bilious fevers. It was not more manifest that 
that epidemic was the product of miasm than that the disease 
wore a sameness which grew out of the strength and purity in 
kind of the poison then infecting the atmosphere. This was 
manifested and confirmed by the sameness, simplicity, and suc- 
cess of the treatment then adopted. It was treated with great 
success by the free use of jalap and calomel, and the cinchona 
bark (the quinia not being known), with now and then the em- 
ployment of bloodletting. Remittents after free purgation, 
and sometimes an emetic, and, in the more robust patients, 
occasionally venesection ; the bark would arrest remitting 
fevers as certainly as it did the intermitting, but the former 
required more time to arrest the fever, while the latter was 
more prone to relapses. 

But, to return to our reviewer. "We have met with cases, 
too, which inclined us to believe that cholera could not only be 
transported by the persons, but likewise by the clothes and bed- 
ding of those laboring under the disease ; and, on some occasions, 
the clothes, &c, were carried to considerable distances before 
being opened out or used, yet they, too, seemed capable of spread- 
ing the disease." Could anything easily be more vaguely ex- 
pressed? To prove one of the most important concerns in 
which the whole world is deeply interested, and while thousands 
of things on record are directly at variance, the reviewer 
hazards the vague expression, " which inclined us to believe that 
cholera could be transported." And again, after speaking of 
the opening of clothes that had been carried a considerable 
distance, "they, too, seemed capable of spreading the disorder." 
Could anything be more vague than this ? These opinions are 
suppositions. But, let us admit the finding of all the evidence 



REMARKABLE EPIDEMIC IN 1804. 185 

claimed in these declarations, and they prove nothing but co- 
incidence of the occurrences; for nothing is better known re- 
specting cholera than that its real outbreaks come suddenly ; 
nothing can account for its widespread action — showing itself 
now here, now there — but a diffusion of choleraic malaria, 
widespread as is the showing of its ugly features. 

The reader may recollect that we have been endeavoring 
elsewhere to prove, that a choleraic atmospherical cycle has 
existed over greater part of the United States for more than 
twenty years past : and, indeed, over the inhabited world ; and 
we wish to express as our opinion, that this cycle will, like others 
that have preceded it, pass away, and give place to something 
different. It may be similar to what we have seen, or it may 
be something new. Owing to the universality of the cause, we 
cannot safely decide, that because a person came from a place 
where cholera visibly existed, and is overtaken with the disease, 
or even if he comes with the disease upon him, and others are 
seen soon afterwards affected with it, that such person brought 
,the seeds of the malady. Such a conclusion would be to deny 
its epidemic character, for here the grand question to be decided 
is, is the choleraic malaria endowed with the attribute of 
ubiquity ? We think this is a truth too clearly manifested to 
be doubted; the course of trade cannot account for the irregu- 
lar periodic recurrence of the disease over the great expanse to 
which it is spread; and surely, whatever is its cause in one 
place, is its cause in all places. Besides, the shortness of its 
duration, in all places, proves incontestably that contagion, of 
animal origin, cannot rule epidemic cholera, for the disease 
having shown itself for a short period, suddenly disappears — 
what can possibly become of the contagion? 

Dr. Carlton assumes the position, that "no complete report 
of the progress of cholera through any of the great kingdoms 
of Europe has as yet appeared." We leave the reader here to 
judge of this assumption, and proceed to notice another as- 
sumption which we cannot see through, as the reviewer seems 
to do. "JSV exertion seems to have been spared to render the 
history of the pestilence complete ; and the whole of the re- 
ports are investigated by Dr. Berg, in a spirit of candor and 



186 EPIDEMIC CHOLERA. 

impartiality which imparts additional value to the facts that 
they contain." We may well ask here, wherein, or in what, can 
we see this spirit of candor and impartiality ? The subject 
treated by Dr. Berg is matter of fact, requiring no adornment 
but truth; and it may be said, that truth is "best adorned 
when adorned the least." 

We are told that, " The sanitary state of those provinces 
that escaped altogether is likewise recorded, and the compara- 
tive spread of the malady in 1834 is briefly noticed." This 
paragraph is intended to support the opinion that the provinces 
which escaped altogether owed that exemption from cholera to 
the absence of a specific animal poison not coming into contact 
with the people of the interior districts. We might ask the 
reviewer here, how many travellers does it take to carry a por- 
tion of choleraic poison from one place to another ? But deso- 
late must be the interior town or district that has no intercourse 
with any of the sea-ports of their country while cholera was 
destroying their countrymen, and strange would be the case, if 
none of these inland people had relatives in the cities, towns, 
and districts located on the sea-coasts. Our author and our 
reviewer hold the notion that a single batch of this pollen-like 
poison will originate a disease of epidemic character. 

We might as well expect a blind man to find the different 
squares of a chess-board, as to find any direct or reliable 
movements, so to speak, of cholera in this country. It is seen 
east, west, north, and south, but with exemptions here and 
there that would bear a comparison with the checkering of the 
chess-board. Whether we look to the severity or the extent of the 
disease, or appearance as to time, it is as undefined as the moves 
on the chess-board. We may see cities, towns, or districts 
where other diseases prevail simultaneously with cholera ; and 
in some cases it is not easy to decide to which of the diseases 
we shall refer such cases in their incipiency ; but, to our ap- 
prehension, they are modifications of one malady, as seen in 
the form of cholera and yellow fever in New Orleans, in 1854. 
Whatever mystery may hang about the disease, one thing, in 
this country, is absolutely certain : the immense travel in the 
United States does not control the epidemic cholera of which 



REMARKABLE EPIDEMIC IN 1804. 187 

we are treating ; naj, more, we may justly say, that while our 
multiform enterprises and unequalled travelling afford oppor- 
tunity to judge of this matter, the benighted and semi-vassal- 
age condition of Sweden lessens the risk of spreading, as the 
phrase is, of epidemic cholera. Of Sweden, in this respect, we 
shall have something to say hereafter. 

" Quarantine on vessels arriving from infected ports seems to 
have been pretty rigidly enforced at all or nearly all the 
quarantine stations along the coast; instances occurred of 
vessels arriving with cholera on board, but by strict seclusion 
from intercourse with the shore, the disease was in almost all 
instances arrested." Dr. Carlton elsewhere says no amount 
of seclusion can exclude cholera. This ipse dixit manner of 
disposing of so momentous a subject cannot be admitted. In 
courts of law, it is required that a witness shall depose to the 
truth, the whole truth, and nothing but the truth. Can we 
agree to anything that is less positive than this oath, in the 
matter before us ? What would a judge say to a witness who 
would say, it "seems" so. Again, " at all or nearly all the 
quarantine stations." Is this declaration sufficiently positive 
in so grave a question as is here under consideration ? " By 
strict seclusion from the shore, the disease was in almost all 
instances arrested." Does this prove anything ? If the 
vigilance was the same in different places, the result ought to 
have been the same. But even waiving the ubiquitariness of 
the cause of epidemic cholera, the number of correlative cir- 
cumstances are so numerous, that we cannot safely draw con- 
clusions without extending our observations to a wider range 
than Sweden affords ; and if no similar uniformity of case after 
case can be traced to contagion, in other countries, similar to 
the catenation reported by Dr. Berg, we are bound to observe 
great caution how we adopt his reports. We do not mean to 
charge wilful misrepresentation ; but we do believe, that the 
field for observation is beset with so much diversity of things, 
that two observers setting out to report those things, the one 
intent on proving the cholera to be contagious, and the other 
that it is not contagious, they will generally disagree in their 
reports. In extended observations, most information must be 



188 EPIDEMIC CHOLERA. 

collected through different individuals. These, too often, will 
suit the reports or alleged facts, to meet the views of those to 
whom they communicate. 

It is clearly manifested by the widely-extended reports be- 
fore us, that our author reports the reports of others, and it 
is but reasonable to suppose that all of those reports came from 
contagionists ; and what medical reader has not seen such in- 
stances of erroneous reports of the contagion of yellow fever, 
being conveyed from place to place, by which it spread in the 
latter, and yet a more cautious investigation has proved con- 
clusively that the disease was indigenous ? In such instances, 
the disease (in the present comparison) was endemic in the one 
case, while in the other it is epidemic, in the most extended 
sense of the term, and neither low streets, " salt herrings, sour 
bread, or sourer milk," are necessary for the origination of a 
contagious disease, as we see in small-pox. These things have 
existed in Sweden for ages, but the epidemic cholera had its 
origin, as we are informed, in 1834. We have elsewhere ex- 
plained our views of the predisponent cause, and of its imme- 
diate exciting cause. 

" The boat arrived at MalmS on the 27th of July, and two 
custom-house officers, who had kept watch on board during 
the stay of the steamer in the harbor, were seized with cho- 
lera, and died. We doubt much, however, if the infection in 
this case can be traced to the stay of these men on board the 
steamer, for they were not attacked with cholera till the 14th 
and 16th of August respectively." If there was room for 
doubt, why did the reviewer notice the cases ? But " the dis- 
ease had already occurred in the dwelling of the custom-house 
officer, Jacobson, on the 11th of August," and several others 
in the family died, in quick succession. The disease is sup- 
posed to have passed from the house of Jacobson to that of J. 
Hansson, also a custom-house officer. We are not told what 
steamer or vessel brought the cholera to Jacobson's house. 
We are not sufficiently well assured that the disease had not 
been seen anywhere else in the town ; but even if it had not 
been, the instances mentioned prove nothing but coincidence 



REMARKABLE EPIDEMIC IN 1804. 189 

of occurrence, and the reviewer admits that "the disease 
in Malmo, as elsewhere, was chiefly confined to the most 
wretched and insalubrious parts of the town, and especially 
in a low-lying quarter called * Bethlehem,' inhabited by the 
laboring classes, and adjoining two swamps, with a filthy 
ditch running through them, filled with stagnant water." In 
this quarter, the mortality was 80 per cent., and from eight to 
nineteen cases occurred in single houses or tenements. Small- 
pox is a disease manifestly contagious, but we see it modified 
in grade by the habit of body of those whom it attacks, as was 
so clearly seen years ago, when we dieted before inoculation. 
But stagnant water in ditches, and low grounds, are not inlets 
to that disease. Why, then, shall we look to these places for 
cholera ? If there be contagion, it must be a unit, and pro- 
duces its likeness, irrespective of mud and mire, for these are 
no novelties. Then, in respect to many cases occurring in the 
same house ; — this is no more than what we see in common epi- 
demic fevers, a remarkable instance of which we have already 
noticed in this work (in 1804). We admit that cholera pre- 
vails principally in malarious places or districts ; but these ive 
alivays have with us, while cholera appears in every country, 
where there was no contagion, neither could he, as manifestly 
as that vegetation rises from the earth. 

Speaking of an outbreak of cholera, about the 12th and 
13th of August, the reviewer says: "The mode in which the 
malady was introduced does not seem to have been satisfactorily 
ascertained. A suspicious case occurred in the person of a 
teacher of languages, named Nordlin, as early as the 3d of 
August, but the first instance when the disease was pronounced 
to be cholera, was observed in the person of a female, Maria 
Jonson, who had attended Nordlin in his illness ; and two or 
three days after (August 6th), was seized with well-marked 
cholera." Here is a confession that the mode of introduction 
was not satisfactorily ascertained, and a true case of cholera is 
derived from it, without any mode of introduction being shown 
of the infection. Shall we call this a case of spontaneous 
origin. " A suspicious case occurred." How suspicious ? be- 
cause there was no proof of contagion or infection ? Never- 



190 EPIDEMIC CHOLERA. 

theless, the case was decided to be unquestionably cholera, and 
•was pronounced so to be from the symptoms, while hundreds 
of cases were pronounced cholera, because, while an epidemic 
disease existed, and a ship arrived from a place where the dis- 
ease prevailed, whether cholera was on board or not, if per- 
sons visited the ship, and were seized with the malady soon 
afterwards, the medical observers of Sweden put these cases 
down as coming from the ship ; but we view the whole affair as 
matter of opinion, and those observers admit, that the co-ope- 
ration of a malarious neighborhood is required to spread the 
disease around. 

It is said that "Malmo contains 12,981 inhabitants; of 
these 378 died out of 1,138 cases of cholera in twelve weeks;" 
and it is supposed by Dr. Berg that all the evil arose from an in- 
fectious matter brought from LUbec by some two or three cases, 
and the suspicious case of Nordlin. This infection had power 
to spread for twelve weeks ; but, notwithstanding the presence 
of nearly twelve thousand people remaining in the town, the 
poison ceased to act any longer. What became of the infec- 
tion ? Shall we suppose that the few individuals who are said 
to have caught the cholera in Malmo, and carried it to the 
country and to adjacent towns, lessened the force of the infec- 
tion, and thus relieved the people of the town ? We think such 
a supposition would be as rational as to suppose that an infec- 
tion could act twelve weeks, and then disappear suddenly. 

"Dr. Stenkula even maintains that the disease can be con- 
veyed by individuals who themselves escape, and instances a 
case in Raa, where two children took the disorder from their 
father, after his return from Malmo, while the latter never ex- 
hibited any symptoms of the disease." This wonderful bit of 
fancy is endorsed by our author and reviewer. We would sup- 
pose a man must be a confirmed contagionist before he could 
adopt such a flimsy notion, the more so, because he soon after- 
wards saw the widely-opened box of Pandora at Malmo, and 
poison poured forth with power to attach itself to the skirt of 
every man's coat, and to the habiliments of the women and 
children, suddenly lose its power, and close down the lid of 
the pestilential box. It is but reasonable to conclude that Dr. 



REMARKABLE EPIDEMIC IN 1804. 191 

Stenkula could not trace the disease of the two children to a 
more satisfactory source, and it is equally clear for us to see 
that there was a more general cause present at Raa, and one 
more satisfactory ; for we have seen hundreds of cases in which 
no possible stretch of the imagination could trace to personal 
infection. "With observers as imaginative as Dr. Stenkula 
shows himself to be, our author might easily be satisfied with 
his own imaginative reports. 

"We observe, too, in the report given by Dr. Grah, that out 
of those employed about the sick, many were attacked with 
cholera. Out of three physicians, two died; of eight male at- 
tendants thus affected, five were carried off, as were likewise 
five nurses out of nine who suffered from cholera." It will not 
be thought remarkable that two physicians, five females, and 
five male nurses, should have died out of 1,138 cases of cholera, 
of which 378 died, when we consider the greater fatigue and 
loss of sleep, anxiety, change of diet, and change of occupation, 
with many nurses ; we may well insist that the proportion of 
cases is not greater than we might look for, nor does there 
seem to be greater proportional mortality than seems reason- 
able, when we consider the increased labor of those people, and 
particularly the physicians : in the present relation, physicians 
are as other people. 

" The principal mortality occurred during the first three 
weeks; but it diminished when better sanitary measures were 
adopted in the hospital." This is a feature universally cha- 
racteristic of cholera, and we are warranted in believing that 
those sanitary measures had nothing to do with the abatement 
of the epidemic. No account of those sanitary measures is 
given by the reviewer; but we could not well imagine what 
those measures could have been. Patients must necessarily 
come in and go out ; and if the infection can be carried in the 
apparel, as is alleged by the reviewer, how can the inmates 
avoid carrying it abroad ? As the disease, as usual, was prin- 
cipally among the poor, we may suppose that many people were 
passed through the hospital. How can we, with any semblance 
of reason, believe that, notwithstanding the infectious nature 
of cholera, people are brought to one great focus, so to speak, 



192 EPIDEMIC CHOLERA. 

and again dispersed, and return to the people, and not spread 
the disease; nay, while the focus is generating infection for the 
imbibition of the miserable clothes which the poor of the 
Swedes generally wear, we are told the disease soon diminished. 
We see nothing here that does not obtain in almost every out- 
break of epidemic cholera. 

"At the farm of Zagarp, half a Swedish mile N.N.E. of 
Malmo, a servant of the name of Nils Perhsson was seized with 
cholera, on the 4th of September, after having been in Malmo 
on the preceding day. This man recovered, as did also his 
friend, Nils Hansson, who had not been in Malmo, but had sat 
some time with Perhsson on the day of his return from the 
town, and who was likewise seized with the disorder the next 
day." We do not doubt as to the facts in these cases ; but the 
conclusions are unworthy of a philosophic physician, and mani- 
fest a degree of credulity and prejudice truly remarkable. We 
will suppose that Perhsson came in contact with the choleraic 
infection, that this infection generated a deadly disease the 
day after its reception, and either by a portion adhering to his 
clothing, or transpiration through the skin, or expiration from 
the lungs, he poisoned his friend Hansson; is there anything 
analogous known to occur in any epidemic ? and we say 
least of all in epidemic cholera : a poison so transmissible, as 
is here admitted, would depopulate every city in which it ap- 
pears. The next case noticed was that of " Hans Tufveson.' ? 
In this case the disease is said to have occurred on the 8th day 
after exposure at Malmo. We would remark here that all 
specific diseases are the product of specific causes, and this is the 
character of all epidemics, and the period of incubation is as 
regular as is the disease. In small-pox this is clearly manifested. 
Has an individual been exposed to the effluvium, or the vario- 
lous matter applied to the skin in a state of abrasion, we 
look for febrile action on the fourth day ; there are exceptions, 
but the uniformity of the thing is almost without exception. 
When general inoculation was practised, we have gone through 
scores of cases, and on the same day found that the inocula- 
tion had failed, or was equally advanced in the course of the 
disease in all the cases. 



REMARKABLE EPIDEMIC IN 1804. 193 

"In almost all cases, the houses where such patients died 
were carefully secluded, and the disease did not spread further." 
"Patients carefully secluded," — how is this to be effected? 
There must be a physician, a nurse, and, in a Christian land, 
there will be some friends ; medicines must be sent for ; the 
body must be buried : how are all these attendants to escape, 
seeing that a poison is generated and transferred, in some cases, 
as is said to have been the case between Perhsson and Hansson ; 
the latter took the cholera the day after sitting with the former, 
and, it is said, he was thus infected ? Who can measure the 
savage treatment which most patients will receive under the 
notion that infection can be warded off by the neglect and se- 
clusion of the sick ? We have an ugly specimen of this savag- 
ism in the instance of a man who came from Malmo, and lay 
in the bed of his brother-in-law, Anderson, and being sick, was 
driven off "by the authorities, and died on his way home, which 
was at Malmo, upwards of four English miles." Superstition 
is a hard master, as we here see, or this sick man would have 
been carried home; for what we know, he died by the wayside, 
without help, for he did not reach home; but, "on the way, the 
symptoms became more and more [as well they might under his 
circumstances] developed, and he expired that evening." On 
the 27th of August [this man, whose name is not given}, the 
brother-in-law of one Anderson, came from Malmo; "and 
Anderson, in whose bed he lay a little while, sickened on the 
30th," that is, three medical days from the hour at which An- 
derson was exposed till the hour on which he sickened on the 
30th. We have had good opportunity for observation, and as 
the disease has appeared under our notice, and also as we read 
of it in nearly all of our cities and towns, &c, we are fully 
confirmed in the opinion that cholera fomes is but a weak and 
slow poison, operating gradually in most cases, perhaps in all, 
and it insidiously disturbs the vital economy, and then, sooner 
or later, becomes an agent of sudden destruction. Hence it is, 
that we see thousands of cases of milder grade in the form 
mostly of cholerine and cholero-dysentery, and we have already 
noticed the circumstance of its most generally (in this country) 
usurping the place of our summer fevers. 
13 



194 EPIDEMIC CHOLERA. 

The reviewer introduces the name of Dr. Stenkula as au- 
thority for the following observations : " As regards the con- 
tagious or non-contagious character of the disease, I have no 
hesitation in declaring, in opposition to the generality of the 
more recent authorities on the subject, that the cholera is es- 
sentially a miasmatic contagious disease. It is true that here, 
as everywhere else in Sweden, diarrhoea, and vomiting, and 
gastric disorders had occurred; but the appearance of this 
malady in a locality so healthy as Raa, introduced, as it cer- 
tainly appears to have been, by communication with an already 
infected locality, is a fact so well established that it cannot be 
disposed of." 

We are told that cholera is "a miasmatic contagious dis- 
order." That in Raa, as everywhere in Sweden, diarrhoea, 
vomiting, and gastric disorders had occurred; and yet, it is 
said the disorder must have been originated by a communica- 
tion with an already infected locality, and introduced by conta- 
gion. Now, what are we to think of the assertion that the 
infection was brought to Raa personally, or by the clothing of 
individuals ? We must infer from what is said that Raa was 
too pure a location to engender or maintain miasm ; and this, 
it is admitted by Dr. Stenkula, is the pabulum upon which 
choleraic infection subsists. This is a most important admission 
of Dr. Stenkula, that those harbingers of cholera did exist not 
only in Raa, but throughout Sweden, i. e., disorders of the 
primse vise. 

The reviewer introduces the authority of Dr. Stenkula again, 
and says: "He, however, fully agrees with the London and 
Christiana reports, in believing that all seclusion of healthy 
districts is unnecessary, save as respects ships arriving from 
infected ports. The advantage, however, of shutting up and 
watching the houses in which the disease may have broken out, 
and of subjecting the inmates of such houses to close observa- 
tion and seclusion for a time, he thinks cannot be denied." 

Dr. Stenkula, whose views are endorsed by Dr. Carlton, has 
expressed as his opinion, that healthy localities need not be 
watched, except the ships which arrive from places where the 
cholera prevails, and yet he declares the cholera to be a conta- 



REMARKABLE EPIDEMIC IN 1S04. 195 

gious miasmatic disorder ; therefore miasm must be a sine qua 
non in the production of the disease. Is miasm transportable? 
Here we see Dr. Stenkula differing with Dr. Strom, whose opi- 
nion respecting prevention is adopted by Dr. Berg and Dr. 
Carlton. Dr. Strom ascribes the escape of the people of the 
city of Lund from cholera to an enormous sanitary cordon, con- 
sisting of seven or eight hundred persons, who perambulated 
the purlieus of Lund day and night; and, it is said, "the dis- 
ease seems to have reached within half a Swedish mile on two 
sides, but no case of cholera occurred within the city." 

Yerily, here is one of the greatest farces ever acted — for 
magnitude, for the zeal, and ignorance, and savagism of the 
actors, it was never equalled. We would ask where were the 
Christian virtues? where were "the bowels of compassion?'' 
where was the common sense of the authorities of Lund, that 
they could send the hordes of superstitious people, to violate 
the first command of God, to love thy neighbor ? All this 
done under a dark cloud, in which might have been seen a 
fearful responsibility of the movers of the scene ; for, in 
Sweden the people are a mass of down-trodden automatons ; 
truly docile, and less depraved than the people of any other 
country in Europe. Had there been a well-marked affiliation 
of the atmospherical and local topical causes of cholera at 
Lund, while this enormous farce was acting, the people who 
were the actors would have been "led like sheep to the 
slaughter" — a fearful responsibility would have rested upon 
the projectors of the experiment, for the exposure of the 
people to the anxiety, loss of rest and sleep, &c, would have 
greatly augmented the predisposition to cholera, and increased 
the number of cases, and the mortality. 

" In Gotheberg, as elsewhere, the disease prevailed chiefly 
in the poorest and the most densely populated quarters of the 
town, and the intemperate were its first victims, but at a later 
period even those of more orderly lives did not escape." This 
has been, to say the least, strongly characteristic of epidemic 
cholera in all countries ; and is as steady a trait of its cha- 
racter as any other circumstance : may we not ascribe this to 
more time being required, in pure habits, to impress the 
system ? 



196 EPIDEMIC CHOLERA. 

" In a town of such great commercial activity, and situated 
on the great highway from Western Europe to Stockholm, and 
the east of Sweden, no measures of seclusion or quarantine 
could be adequately enforced." That there could not be any 
adequate means applied to seclude epidemic cholera admits of 
no doubt. This being the state of the case, all attempts 
at seclusion in large towns would be folly, for even if it were 
infectious it could not be kept out ; but, the frequent exemp- 
tion of large towns while cholera exists at other towns, both 
large and small, not far off, affords strong grounds for believing 
that there is no transferable quality in the exciting cause of 
cholera, for it is a thing which does not follow the course 
of the winds — we need not multiply instances, for they are too 
common to require it ; but, we speak here in reference to great 
or prevailing winds — we will, hereafter, refer to a preceding 
part of this work where Dr. Fricke assures us that the course 
of the wind was opposite to that of the course of the cholera 
at Hamburg (1831), but, wherever the parasitic cause rises in a 
body, the winds prevailing in a course from this nidus to the 
streets of a town, an invasion takes place, and more or less 
victims falling before it, the disease, in its malignant form, 
will cease sometimes in a few days ; and almost never lasts in 
its malignant form more than a few weeks as an epidemic — 
how can we reconcile ourselves to this condition of things, 
seeing as we do, that this obtains in all cases alike, i. e., 
whether there be quarantine, sanitary cordons, or watchers, 
or scarecrows. 

It may be truly averred that, wherever the epidemic has ap- 
peared in different countries, more or less of the towns, or dis- 
tricts, are exempted, and, we believe, it is a law governing 
epidemic cholera, that as the malady shall appear more or less 
malignant in some locations, so will be the greater number of 
exemptions in places around. 

" The interruption of trade by a strict quarantine, and the 
consequent loss of employment to thousands of the working 
classes, would have brought them to the brink of starvation, 
and would have rendered them ready victims to the pestilence, 
which sooner or later would have made its way into the city 



REMARKABLE EPIDEMIC IN 1804. 197 

with the great crowd of travellers that could not be arrested 
or turned aside." We have here an implied admission that 
quarantine would have subjected the people of the town to 
vastly increased evils, not only as relates to subsistence, but 
by an increase of the disease, and, the infection could not 
have been kept out. Before we close this review of the 
Swedish reports, we shall have something to say respecting 
the boasted commerce, and some other things in Gotheborg. 

" In Thorsby parish, Anna Johannisdotter (aged 24), slept 
one night in Gotheborg, in a bed from which the body of one 
of her relatives who had died of cholera had just been re- 
moved. On the following day (November 3d,) she was 
attacked with cholera on her way home, and died on the 6th." 
What shall we say to an announcement so wonderfully absurd, 
as is here presented. How shall we conceive of an invisible 
infection, lodged upon a bed by one sick of cholera, that is so 
deleterious that it will invade another body in health, and show 
itself in the second person in deadly strife, in twenty-four 
hours, or perhaps less, since we see that this woman sickened 
on "the following day" after exposure to the elfish infection. 

The people of Thorsby are sneered at by the reviewer for 
their want of common sense — as we see in the following 
words : " That the disease would spread no farther than God 
permitted, and that all seclusion was unavailing." Has not 
the reviewer admitted that, in great commercial towns no 
quarantine or seclusion would keep the disease from entering, 
for that was the case with Gotheborg ? How can we expect 
anything better at Thorsby, or elsewhere, except in greater 
degree in one place than in the other ? All the circumstances 
are the same, except in degree. And, however much the 
medical observers, concerned in the cholera reports, may laugh 
at the Thorsby decision, we are decidedly of the opinion that 
nothing has been said in those reports which shows more wis- 
dom than that the disease would only spread as far as God 
would permit. We have here a case in which there is a univer- 
sal contamination of the atmosphere, and the co-operation of 
some sort of malaria is necessary to give play to the choleraic 
influence ; how else are we to look for the spread of the disease 



198 EPIDEMIC CHOLERA. 

about "the ditches at Malmo, and the low, filthy places there?" 
Well, if this be admitted, the disease will not spread without 
the proper medium, through which the specific infection 
operates. 

And here we have cause for gratitude to that Providence 
which in the main works for our good ; and we find that in 
doing the duty of Christians towards each other, or doing as 
we would wish to be done by, that we shall contribute best 
to the general safety, and to our own. Let the actors of such 
scenes as turning the sick out of doors, driving them off because 
they have been where there was a desolating sickness, beware. 
Shall we shut up patients in houses to smother, lest the elfs 
shall ride upon the air, and disseminate poison upon those 
that would do kind offices to the sick ? It is truly consoling 
that, notwithstanding the pretensions of the Swedish authori- 
ties before us, the mortality in 1850 was as great — we think 
greater — and its duration quite as long in its several locations, 
as in the United States, where no attention whatever has been 
paid to seclusive measures ; so that, we may well say, attend 
to the purification of the atmosphere, and control the people 
in habits of temperance and regularity of living, so far as in 
our power, and we may rely upon it that Providence will speed 
our measures, and God himself accept our kind ofiices to our 
fellow-creatures. We "speak of the things that we have seen," 
and not as one who offers secondhanded reports. We by no 
means advocate blind fatality. But cholera, though protean 
in its nature, has its laws, and the first great law is the uni- 
versality of its cause, which makes manifestation of its exist- 
ence in a peculiar infestation of a settled constitution, which 
is properly designated by the epithet cycle, and this cycle has 
operated in our country sporadically, endemically, and epide- 
mically for upwards of twenty years, by reason of its ubiqui- 
tariousness. How vain then to strive against the air we breathe ! 
All attempts at seclusion but begets a false confidence, for the 
choleraic principle has dominion over the face of the ground, 
and while it banishes many other diseases from the general 
soil, which are the product of malarious materials, takes pre- 
cedence, and you may as well attempt to arrest the high-soaring 



REMARKABLE EPIDEMIC IN 1804. 199 

eagle in his flight, as to arrest the cause of epidemic cholera, 
for, it is, so to speak, out of sights out of reach, out of any 
morbific categoric of disorders, for, it is not of itself a tangi- 
ble cause of sickness, but a ruling principle. We see electri- 
city and other grand principles operating throughout space, 
and yet have we no conception of their nature. Electricity 
acts upon matter universally ; and so with the choleraic prin- 
ciple, it is seen now here, anon elsewhere ; it rules as a princi- 
ple, and seems to commingle with a malarious material ; for, 
keep away a certain malaria, according to Swedish doctrine, 
and we have no cholera ; so, on the other hand, since the exist- 
ence of the choleraic principle, let this malarious material 
accumulate, and we have cholera. If this were not a true 
explanation of our subject, why was it that miasm has been 
seen so long to produce certain diseases ; but now domiciliates 
a new disease, and that disease the offspring of a new principle, 
well entitled to what has been termed a new cycle in our 
atmosphere, or the aeriform constitution of Sydenham. 

"When the sudden change from oppressively hot to cold 
and windy weather took place in August, 1850, diarrhoea and 
colicky pains in the bowels became frequent, but these 
diminished remarkably before the first cases of cholera ap- 
peared, about the 22d of September." We have already 
noticed what Dr. Stenkula (who is considered good authority), 
has said, that at Raa, as well as in every other place in 
Sweden where cholera appeared, it was preceded by diarrhoea, 
vomiting, and gastric affections. Now, as this obtains almost 
everywhere else, we may insist upon that condition as being 
allied with epidemic cholera, and the acknowledgment of the 
same state of things at Gotheborg in August, at which time 
these affections must have been quite prevalent, since " they 
diminished remarkably" before the cholera appeared — does 
not this strongly resemble a quibble ? What gave rise to 
those intestinal affections ? Had the atmosphere anything to- 
do with it ? Had the atmosphere entirely changed its cha- 
racter in a few days ? Does not a philosophical examination, 
of this subject afford the conclusion that the diseases of that 
season, being seated in the same viscera, and, beginning 



200 EPIDEMIC CHOLERA. 

mildly, and gaining strength as the season advanced, that the 
whole was the product of one unwholesome atmosphere ? This 
is nothing remarkable that there should be an interval, for we 
see that the cholera in its malignant stage, after prevailing 
one, two, or three weeks, almost always becomes milder, and 
soon ceases altogether. Why does it cease till it has produced 
utter desolation if there be an infection so potent that it 
attaches to clothing and bedding, and has the quality of infect- 
ing persons who come near in the open air ? and it is alleged by 
the authorities before us, that the infection may be carried to 
a distance, and will act at an indefinite time. 

Our observers obviously turn to the supposed interregnum of 
the cholera at Gbtheborg in 1850, with a view of strengthen- 
ing their position in relation to the disease having been ori- 
ginated by imported or transported contagion, and we are told 
that the disease first made its appearance among the shipping 
and boatmen. We say, well it might; for this is the place to 
look for malaria, without which cholera seldom exists epidemi- 
cally. We see the disease sprouting gradually in Gb'theborg, 
as it does in all places where it acts extensively. In August, it 
"diminished remarkably" (but not entirely); the same influ- 
ences were seen to be at work, and soon attained greater force; 
for those diseases not seemingly cholera in the eyes of the con- 
tagionist, were positively the disease itself, yet in the stage of 
cholerine and cholero-dysentery ; and now, in the primary 
stage of the epidemic, was the time for increased vigilance in 
efforts for out- door purification, and to restrain the people from 
all excitement, to moderate their labors and food, if plentiful, and 
improve it if too mean ; in a word, a well-measured observance 
of the non-naturals, and scrupulous exactitude in applying 
early for medical treatment; for, like many other things, when 
taken in the bud, the disease can be treated with great success, 
i. e., there is a point when the system is on the verge of being 
fatally impressed, when the disease will yield in much greater 
degree than is generally believed. There is a period when, in 
most subjects, there is a state of oppression too often mistaken 
for depression, so that the disease, as we have seen it at this 
very point, is to be treated actively by depletory remedies, as 



KEMARKABLE EPIDEMIC IN 1804. 201 

we have already shown, and shall still further illustrate and 
tell of the means. 

"At the mouth of the Gotha Elv, the great channel of water 
communication across Sweden to Stockholm, lies the large town 
of Gb'theborg, — a considerable town at least for Sweden, for it 
contains 21,000 inhabitants. In 1884, this busy trading and 
manufacturing town was most severely visited by the pesti- 
lence, which carried off 1700 of the inhabitants."* Such a 
mortality, as is here reported, evinces but little skill in the 
treatment of the disorder ; and it would be well for the physi- 
cians of Sweden, and contagionists everywhere, to turn their 
attention and their talents to the cure of the malady, rather 
than pursue an ignis fatuus in the search after contagion; for 
our reviewer acknowledges that no measures of quarantine or 
seclusion can exclude the epidemic cholera from large towns. 

" The trade of Gotheborg, and the vast internal trade to- 
wards ; and to Stockholm," leads us to digress, for a brief space, 
to say something respecting the town of Gotheborg as we saw 
it in 1830. It was reputed to contain 20,000 inhabitants ; but 
in every aspect unlike, as we thought, anything of commercial 
or manufacturing importance. In passing the vast warehouses 
of the famous English East India Company, in a state of ne- 
glect and dilapidation, one was forcibly reminded of the uncer- 
tainty of the things of this world ; that colossal scheme, and the 
damning iniquities and cruelties which thence arose, are still 
portentous of things that were and will be ; for the forlorn 
condition of the capacious buildings before us are but a particle 
in the world-wide branches of that once opulent company. 

No people can prosper in the cities, towns, or manufactories, 
under the present laws of Sweden ; they are in a state of semi- 
vassalage, with laws subversive of enterprise. The females are 
degraded, and compelled, in good degree, to dress according to 
rank, — common women are not allowed to wear bonnets, and 
are kept altogether as menials. In passing through a public 
part of the city, we saw two men at work in erecting what was 
said to be a public bath-house ; two bricklayers were at work 

* In Baltimore, with a population of over 150,000, we lost 853 in 1832, 
and nearly all of the baser sort. 



202 EPIDEMIC CHOLERA. 

on the second story, and they had a woman as their hod-carrier. 
She was a good-looking woman, being somewhat stout, as is 
very common in Sweden. She was dressed, in October, in a 
petticoat of exceeding coarse linen, and a chemise not much 
finer ; like a man, she took a great load of mortar or bricks in 
a large hod, and walked with it up a ladder. 

Our letters led us to the acquaintance of Alexander Barkly, 
Esq., a Scotch gentleman, who had acquired a large fortune, 
and stood at the head of society, and at his house we dined 
with Dr. Dod, quite an old gentleman, who was the oldest 
Baron in Sweden, and was, therefore, by the laws of that king- 
dom, ex officio king, in the event of the demise of the king 
without a legal heir to the crown. Such an introduction and 
acquaintance led to the best hotel in the city, with wife and 
daughter. This was said to be the best by our friends, and 
though we were comfortably provided for, in whatever aspect 
we might view it, the house was not superior to what might be 
called a fourth class hotel in the United States, or a good 
country tavern. 

We thought everything about the city had a forlorn appear- 
ance, nothing wearing the appearance of activity or enterprise. 
"We were informed that there was but one apothecary in the 
town, and he had acquired a large fortune, as well he might, 
as no one could rival him, he being exclusively privileged. We 
called to procure ten grains of calomel ; not liking its appear- 
ance, we made some remark, and the young man in the shop 
assured us it was perfectly pure, having been make after the 
process of Scheele — that is, by precipitation instead of subli- 
mation. It was taken by the daughter of the present writer; 
having swallowed it hastily, she exclaimed in agony, that she 
had swallowed corrosive sublimate (the article not having been 
properly edulcorated), that it was burning her violently: eggs 
were procured as speedily as possible; but there being less 
than half a dozen in the house, we had to resort to two or three 
tumblerfuls of raw flour and water, after using the white of 
the eggs, before the burning sensation was relieved. A want 
of the proper antidote (albumen) to the bichloride of mercury, 
would probably have been attended with much danger. Ar- 



REMARKABLE EPIDEMIC IN 1804. 203 

rangements had been made, through our friends, for us to visit 
the domicil of a Baron, whose name we do not recollect, but 
who resided six miles from Gotheborg, and we were informed 
that, in our passage there, we should have to pass under the 
iron cage, in which a man had been gibbeted, and now exhi- 
bited his crumbling skeleton — a cruel scarecrow to evil-doers 
in the kingdom of Sweden. 

Were we a resident of Sweden, and afraid of choleraic con- 
tagion, we should be almost as much afraid of the diffusion of 
contagion by the currency as by the wearing apparel of the 
inhabitants — both are of bad quality. The currency of Gothe- 
borg, when we were there, consisted almost entirely of small 
tickets, of which there are two kinds : one purporting to be so 
much specie, and the other so much current, between them 
there is a small fraction ; but so familiar are the shopkeepers 
and servant girls of hotels that they will tell you, with sur- 
prising quickness, that your bill is so much specie or so much 
current, meaning, in both cases, paper money. These tokens 
for money pass readily, so long as the value of it may be seen 
at one point, however dirty or ragged : to show their abundance, 
we will state a small occurrence. Having occasion for twenty 
dollars, we applied to the captain with whom we were to sail 
for New York for a loan ; turning down his hat, he emptied 
what must have half filled a high-crowned hat ; he remarked, 
that if we would take the trouble to count it (he being on his 
way to his ship), it was at our service. After looking at it, 
there being, perhaps, upwards of fifty pieces (a little way 
through), we perceived that the whole would not amount to one- 
fourth of what we wanted ; here were notes of the value of two 
schillings (the schilling about equivalent to the English penny), 
and upwards, on a very small scale. The tokens are printed 
on very small strips of rough foolscap paper, with the most 
common Roman type, and could be counterfeited so easily that 
they would not serve as a currency in any country in Christen- 
dom except Sweden. We had provided ourselves with $100 
Swedish notes at Copenhagen, printed on tissue paper quarto 
size. 

We were informed while there that the town contained 



204 EPIDEMIC CHOLERA. 

20,000 inhabitants; — we were forthwith honored with the free- 
dom of the city, through the influence of Captain Dunbar, 
who was then an old trader between New Bedford, Massa- 
chusetts, and Gotheborg. 

We did not make it specially our business to look for medi- 
cal men, but we heard of none but two, Dr. Lambert and Dr. 
Westring, both of whom we understood were Germans, — the 
latter had charge of a considerable hospital, and the former 
was the Port Physician, — both gentlemen of good acquirements : 
they were attentive to us as a stranger. Far be it from us to 
underrate. Gotheborg is the principal commercial city of 
Sweden ; but when we look at the seeming boasting of the re- 
ports that the business is so great that the diffusion of choleraic 
infection cannot be restrained, owing to the activity of busi- 
ness, we say, there is here unfair exaggeration ; compared 
with our principal cities, the difference is as that between the 
giant and the pigmy, and we find nothing relating to our cities 
and epidemic cholera that is not utterly at variance with the 
Gotheborg reports, as portrayed by Dr. Berg. 

Having disposed of our observations respecting Gotheborg, 
we hope the reader will excuse us for a little further digression, 
while we speak of a few other things which we saw in Sweden, 
believing that what we have to say is not altogether irrelevant 
to the condition of that country in regard to epidemics. In 
entering Sweden, we crossed the Sound at Elsinore, and landed 
at Hellsingborg. When we landed, a custom-house officer came 
down to the boat, from a wharf in a miserable state of dilapi- 
dation, to demand our passport, which, in Germany, Denmark, 
and Sweden, as far as we saw, was termed a pass. Of this 
officer we wish to say a word or two. He was a man of small 
stature, particularly for a Swede, having very red hair and 
a freckled face ; he wore a huge pair of boots, which met buck- 
skin breeches at the knees, both wearing a venerable aspect ; 
a very long-skirted blue coat, and towering chapeau de bras, 
and by his side was swung a massy sword in iron scabbard ; and 
whether we look to the exterior of the costume, or the cut of 
his cloth, we might well go back through a long line of his an- 
cestry and still find its likeness. It was sufficiently martial to 



REMARKABLE EPIDEMIC IN 1804. 205 

look upon for the office he held; but there was a time when it 
might have been the habiliment of his father, or grandsire; and 
for battle-field or encampment, for purification good, it would 
have been improved in its good looks, and of nearer kindred to 
hygiene. 

In crossing the Sound, four English miles wide at this point, 
in a small row-boat, we had the pleasure of being shown, by 
Professor Eckstrom, Surgeon to the King of Sweden, the for- 
mer residence of the distinguished astronomer and philosopher, 
Tycho Brahe, — its elevated site afforded a fine view of the 
white house. We had the pleasure of forming the acquaintance 
of the Professor at the Medical Meeting at Hamburg, in 1830, 
and, failing in with him at Elsinore, he politely gave us infor- 
mation respecting the mode of travelling in Sweden. He was 
a gentleman of fine talents, had travelled much through France 
and England, and spoke the English language very correctly, 
as did his countryman the celebrated Berzelius, whom we 
found to be a gentleman of bland, pleasing deportment, while 
we sojourned at Hamburg. We admire and love the people of 
Sweden ; but the government is the personation of tyranny, 
and here, as everywhere else, gives an aspect worse than pros- 
perity over everything it rules. 

We found a very pleasant landlord at Hellsingborg, and a 
comfortable house. Arrangements were made for the morning 
after our arrival for setting out for Gotheborg. Travellers in 
Sweden are under the protection of government. By describ- 
ing our own passage from Hellsingborg to Gotheborg, we 
shall give a specimen of travel in that country. A coachman 
was procured, who provided the coach and horses to start with, 
furnished us with the expense for relays of horses, tolls for 
bridges ; from the beginning to the end of our journey, the 
amount being advanced to the coachman, we had no interrup- 
tion. They have what is termed a forebode, — a boy with one 
horse and a light cart, — this forebode is started two hours in 
advance of the coach, and notifies, as he keeps in advance, that 
a certain party are approaching, who want so many horses, 
breakfast, dinner, accommodations for the night, as the case 
may be, — by law they are obliged to be ready, or incur a 



206 EPIDEMIC CHOLERA. 

penalty. When you arrive, everything will be ready, — horses 
at the door, meals on the table, or ready to put on. The fore- 
bode carries your baggage, and it is at the risk of the govern- 
ment ; but without the forebode, it is not. Charges are very 
moderate, the price for horses, &c, being under public regu- 
lation. The roads are at least equal to any in the world ; from 
Hellsingborg to Gotheborg, one hundred and fifty miles, may 
be said to be like a bowling-green, not a stone to be seen that 
would cause a jolt, although they, in some places, wind through 
gaps of high hills, some of which seem to be formed exclusively 
of stone, and are devoid of timber or vegetation. Their horses 
are small and go unshod, will travel six or seven miles per 
hour without apparent fatigue. 

In travelling, we did not meet a single road-wagon, nor did 
we, to the best of our recollection, meet or overtake a single 
carriage, and everything wore the appearance of lack of enter- 
prise. There is much water-power in some of their streams, and 
we were surprised, at one place, to see one of the finest streams 
we ever saw with rapid current, having a windmill on its high 
bank, near the bridge we crossed. We will here notice a small 
affair, which, however trifling in itself, is characteristic of what 
obtains with the lower orders of Swedes, and having a bearing 
on their hygiene. At one of the places where we changed 
horses, the woman of the house, about sixty, wore a cap that 
defied any one to tell what it had been made of; it fitted close 
to her head, and had been worn till it had the appearance of 
buckskin that had been glossed with dirt. We would not have 
been surprised to have heard that it had passed its fortieth 
year of age. Such things are capable of producing disease 
without contagion, by generating malaria. 

One incident more, and we shall drop this digressive por- 
traiture. It shows the tyranny of their laws and usages. We 
arrived at the last relay for horses, and found the master of 
the house absent, and that the young man whom he left to pro- 
vide horses for us had gone off to a mill-dam with the horses, 
and did not return for about two hours. When he came, the 
coachman attacked and struck him four or five blows at the junc- 
tion between his head and neck with his utmost power, and from 



REMARKABLE EPIDEMIC IN 1804. 207 

the part selected, and the violence of the blows, he must have 
intended to kill him. We were alarmed, and peremptorily 
commanded him to desist. The young man must have had 
something of a bull's neck, for he did not show any damage, 
whatever pain he may have felt. In this mode of travelling, 
it is necessary for some one to accompany the coach to take 
back the horses, and we were told that it is optional with the 
coachman whether that person sit on the seat with him or run 
seven, eight or ten miles beside the coach, or run the risk of 
losing the horses in his care. As we were about to start, it 
began to rain, and it rained violently while we went rapidly 
not less than two miles ; during this time we had a runner run- 
ning through rain, mud, and mire. It was in vain that we re- 
peatedly begged the coachman to take the young man up. No 
longer willing to bear the sight of such cruelty, we advanced 
and clapped him on the shoulder, and declared positively that 
if he did not take his runner in, we would leave the coach at 
all hazards, and thus we succeeded in relieving the young man, 
who, under all the circumstances, was running at the risk of 
his life ; yet the coachman, independent of this act, was obliging, 
polite/and master of his business. 

There is such a continued sameness in the Swedish reports, 
that we might venture to assert here their utter erroneousness, 
by a simple comparison with what has been observed in every 
other country ; but some of the observations are so special and 
so peculiar, that we deem advisable to continue our examina- 
tion somewhat further. 

" The reports of the district physician Dr. Ossbahr, plainly 
show that the inhabitants at Tjorn, really exposed themselves 
in every way to the pestilence, and that they were in such a 
condition as regards their customs and their habits, as pre-emi- 
nently to favor the progress of cholera. The mortality in 
Tjorn, seems to have much exceeded the usual average. Out 
of fifty-one cases twenty deaths are recorded." How are we 
to understand the assertion that " the people exposed them- 
selves to the disease in every way ?" We suppose that here 
as everywhere else the people attended to their business, only 
they did not look out for that which could neither be seen nor 



208 EPIDEMIC CHOLEKA. 

controlled; but, says Dr. Ossbahr — " they were in such a con- 
dition as regards their customs and their habits, as were pre- 
eminently favorable to the progress of cholera." If cholera 
progresses by infection, why shall we associate habits and cus- 
toms with it ? We take it that there is one cause, and one 
morbid condition in begetting and passing cholera through 
a place ; and, whether that place be small or large, it runs its 
course at most, in a few weeks, and like a will o' the wisp, it is 
presently seen somewhere else. What becomes of the conta- 
gion, which, according to the Swedish reports, generally gained 
its greatest malignity about the end of the third week ? But 
mark the singular insinuation, that the mortality was greater 
here than usual, and " seems much to have exceeded the usual 
average." Does the reporter here wish to convey the notion, 
that the carelessness of the people in neglecting the usual 
seclusive Swedish measures, thereby augmented the propor- 
tional mortality ? Does not this militate against the notion of 
contagion ? and is it not strongly in favor of a morbific matrix 
in the atmosphere, and that there is supperadded a secondary 
morbific entity to the primary contamination ? And, we believe, 
as the force and extent of the secondary cause, so will be the 
extent and malignancy of the epidemic malady. 

" In Areby, when the disorder first appeared, the greater 
part of the inhabitants were attacked, and only three recovered. 
It was observed, too, on the other farms, that most of the cases 
occurred in one or two houses or families." The excessive 
mortality at Areby is ascribed, by Dr. Ossbahr, to the cir- 
cumstances that three families, which before had inhabited 
separate chambers, all " upon occasion of the first death from 
cholera crowded themselves into a single room, wherein chil- 
dren and adults, the diseased and the healthy, continued to 
reside, in the most extreme misery and filth." We are left to 
guess at the greatness of the mortality at Areby, since we are 
told that three died, but not how many were sick. On the 
other farms, too, most of the cases occurred in one or two 
houses. Indeed ! one or two, no matter which. The inhabi- 
tants after one death crowded into one room, there to undergo 
the privations of a crowded space and filthiness. Doubtless 



REMARKABLE EPIDEMIC IN 1804. 209 

such a state of things would increase the risk of febrile diseases 
whether cholera or not, but have we not seen for ages, that 
such things will generate malaria, which, until the last few 
years, never partook of the choleraic character ? Our reporters 
would here contend that this is a proof of the presence of 
contagion, but to say nothing of other countries, our observa- 
tions throughout this vastly extended country are entirely at 
variance with those so sedulously advocated by the doctors of 
Sweden — here is a strong instance of the opprobrium, doctores 
dividuntur. Still, all this is reconcilable to truth, as to the 
facts; and though "facts" are " stubborn things," it is but 
too common for observers to draw therefrom wrong conclusions, 
and in no department of philosophical inquiry has it obtained 
more than in the science of medicine. 

Dr. Ossbahr, who was one of the district physicians, during 
the epidemic of 1850, reports that, " it was impossible for me 
to obtain attendants to wait upon the sick, except among their 
nearest relations. At length I persuaded a few, both men and 
women, to undertake this office; but alas ! after a few days, 
the best and the most active nurse, Anna Olsdotter, took the 
disease, and still worse, she died!" We may here raise a 
question as to the moral, involved in striving to "persuade" 
a person to undertake the office of a nurse, in a disease believed, 
by the persuader, to be so deadly infectious that a man by 
lying down a little while in a bed where a person had died of 
the disease, or by reading prayers beside a sick person, or by 
associating with a person whose clothes were so imbued with 
the fomes of the disease, that, whereas it could not find an 
entrance into his body, took occasion to immolate his two chil- 
dren ; all these and many other preposterous items ; we will not 
honor them with the name of facts ; they are mere supposi- 
tions ; — after all, we do not believe there was anything like 
manslaughter in this case, seeing, as we believe, that as re- 
garded the origin of the disease, all who breathed the choleraic 
air through that part of Sweden, were liable to be affected, 
modified only by their condition as regards the non-naturals. 
Persuasion in such a case should be addressed to near relatives, 
for no hire can compensate for the business of nursing, if the 
14 



210 EPIDEMIC CHOLERA. 

disease is really under the control of a personal infection of a 
most terrible deadliness. 

Dr. Ossbahr continues, — " When I first arrived on the Island 
(Nov. 30), I earnestly entreated the authorities not to permit 
the healthy and the diseased to remain in the same chamber. 
This, however, was neglected, or no measures were taken to 
enforce obedience. During the first days of my residence at 
Tjorn, the doors of the affected houses were constantly closed 
to me, nor could I anywhere obtain the requisite attendance on 
the sick ; but no inhabitant ever hesitated to attend the 
funerals of the cholera victims, where brandy with camphor 
dissolved therein, was swallowed in immense quantities." 

It may be remarked here that, Dr. Ossbahr took charge of 
his district strongly impressed with a belief, that the most 
malignant contagiousness belonged to epidemic cholera ; no 
wonder, therefore, that he frightened those simple people so as 
to fear each other ; and, still more to look upon the physician 
as the carrier of the seed of the malady ; for, to them it might 
seem, if he excited their fears of each other, and that it was 
his interest to spread the seed, that it might produce to him a 
harvest, in the expected crop of disorder, by which they saw 
him get his living ; nor would they readily believe that he 
would risk his own life, unless he possessed some prophylactic, 
which they did not. Something like this might have been the 
reason why the doors of infected houses were constantly closed 
to me (him), " as the doctor reports. A poor compliment is 
here paid the populace in charging them with so strong a 
liking for the ardent — it is, however, probable they were led 
by some notion of its preventive qualities, and therefore, it is 
not unreasonable to charge the doctor with being negatively 
the cause ; for, it seems that the authorities] differed with the 
doctor, as to the contagion, as we shall presently show ; seeing 
the doctor striving to compel the authorities to separate the 
well from the sick, and contending, too, that the disease is in 
the highest possible degree contagious, while the authorities 
contended that, not one in a hundred, who had visited Gothe- 
borg, the pandemonium from which the doctor derived the pesti- 
lence, were infected. The local authorities f assert that not one 



REMARKABLE EPIDEMIC IN 1804. 211 

of a hundred individuals who visited Gotheborg, while the 
cholera raged in that town, were affected with the disease either 
there or on their return to Tjorn.' But, says the reviewer, Dr. 
Ossbahr tells a very different story, without however directly 
contradicting the assertion." 

What shall we say here ? The above discrepancy is matter 
of fact. Shall we belie ?e that the respectable individuals 
who composed the sanitary board were as well, and probably 
better informed, in respect to trade and travel between Gothe- 
borg and Tjorn, than the doctor? The doctor says, "when I 
arrived on the Island (Nov. 30), to take charge of the district." 
From this fact, we have a right to believe, that the doctor was 
sent there by the influence of Dr. Berg, who seems to have 
been fortunate in having all his correspondents contagionists. 
The discrict physician could not have as early or more full 
particulars of arrival and seizures of the disease as the local 
authorities. But how shall we dispose of the assertion that, 
the doctor made a statement of facts ; the authorities another 
directly contrary ; and yet, the doctor disproves their asser- 
tions, " without however directly contradicting the above asser- 
tion ?" We leave those who can, to reconcile these assertions, 
so diametrically opposite, for we cannot. 

Dr. Ossbahr reports that the local authorities would not 
enforce his desire and advice, that the sick and the well should 
not remain in the same chamber ; but it was not enforced. So 
far as we saw Swedish houses, they are very small in the 
country and villages ; seldom having more than kitchen and 
one room down stairs, and a loft or two above ; now what can be 
done in such a case ? Will you drag the sick from their 
homes, and put them into hospitals by force ? But, this cruel 
expedient is not likely to answer any good purpose, but would 
increase the risk of spreading the disease if it be really con- 
tagious, for do what you will, the sick, if nursed at all, must 
"have nurses that are well. Could we believe the reports, as 
made by the physicians (we mean the conclusions), who catered 
for Dr. Berg, to find one alive after the epidemic in Sweden 
(1850), would wear much the appearance of a miracle ; nay, 
we may reasonably ask, how did they escape immolation ? 

We are told, in the Swedish reports, that some clothes re- 



212 EPIDEMIC CHOLERA. 

maining from persons who had died of cholera were unpacked 
and sold, and that a man named Jacob Christansson, who had 
attended the sale of these clothes, was seized the day after, 
Nov. 16th, with cholera, and died ; and six fell victims to the 
contagion, caught at the same time. We are not told what'be- 
came of those pestiferous clothes. We may reasonably imagine, 
if such havoc had arisen from that lot of clothing, that people 
might have been destroyed by scores or hundreds, if the poison 
is so potent and so diffusible, for those six victims must have 
left clothes, and their bodies, like his of whom they imbibed 
the poison, must have generated the same seeds of pestilence 
wherever they were taken. 

" Unhealthy and crowded dwellings, want, and intemperance, 
greatly increased the number of victims ; and it was observed 
that the malady was peculiarly severe in those families where 
many individuals resided in one or two small rooms ; while, 
when cholera appeared among the better classes, it seldom spread 
to the rest of the household, especially where the dwellings 
were large, airy, and well kept." What are we to infer from 
the above paragraph ? That material susceptible of ozoniza- 
tion must be present ; but we cannot safely conclude that the 
disease is the product of a local specific infection, except where 
there exists a choleraic poison in the general atmosphere, and 
such a poison has so existed over Europe and North America 
for more than twenty years. We admit that malaria arising 
from small, crowded, dirty houses increased the risk of seizures 
of cholera, and the altitude of chambers, we believe, has a 
strong bearing on the fomes of the disease ; but other things 
are to be taken into the account — poorer living, greater fatigue, 
and the use of food affording little nutriment, and not always 
in a state of purity and freshness. Does the reporter mean to 
say, that the space intervening between the sick and the well, 
in large houses, diminishes the risk of contagion ? Such an 
opinion is not sustained by common sense, nor by experience. 
We shall show hereafter, its utter fallacy, by the exposition of 
cases in epidemics which we have seen. 

" Two old persons, man and wife, who lived about an English 
mile from Stafered, but were not known to have had any com- 



KEMAKKABLE EPIDEMIC IN 1804. 213 

munication with infected persons, were attacked with the dis- 
ease, almost at the same hour and both soon died." 

In the instance before us, it is acknowledged that the man 
and his wife were not known to have been exposed to the in- 
fection ; but, nevertheless, the reporter says, they infected the 
nurse who attended them, and from this woman they charge 
the spread of the pestilence. If this were the nature of these 
circumstances, how could the disease ever be arrested ? From 
the zeal with which cases are hunted up to support the notion 
of personal infection, we may safely conclude there had been 
no such exposure ; and this is a fact which might well have ar- 
rested the special attention of the medical observers ; for it is a 
matter of the deepest concern to mankind to know where the 
fomes of cholera has its being, since it is by such knowledge 
only that we can adopt prophylactic measures, and great are 
the evils attendant upon the adoption of the belief of personal 
infection or contagion; for we think it hardly will be questioned, 
that cholera is always the result of the same agency* If these 
old persons were affected with epidemic cholera, all the labor of 
the Swedish physicians to establish an infectious character for 
the disease, must sink beneath a just inquiry, for there was no 
exposure. 

" A soldier, who had conversed with this man, in the open 
air, after his return, but had not visited his house, took the 
disease on the 22d of November, and before the 28th of that 
month, two of this man's children died of cholera, while an- 
other child, and his wife, were severely affected." The account 
then goes on to trace a number of cases and deaths derived 
from the case of the soldier, who was slain, not on the field of 
battle, but by the seeds of pestilence seizing fast hold of 
him in the open air, because he dared to stand, not at the can- 
non's mouth, but as a mere civilian, before one who now, like a 
porcupine throwing off his quills, or the skunk his odiousness, 
pierced his body with unseen darts, armed with potency to kill, 
and kill and travel, and travel and kill, with an unseen besom, 
made up of deadly tissues. 

"The village where these cases were observed was, as regards 
its sanitary condition, eminently favorable to the progress of cho- 



214 EPIDEMIC CHOLERA. 

lera. Large dunghills were accumulated around the cottages, the 
inhabitants were crowded together in dark and filthy chambers, 
to which fresh air never found access, while their diet was little if 
at all better than that of the Irish peasantry." There is nothing 
remarkable in all this as regards the mode of living throughout 
Swedish villages, where boys are seen going to school without 
hats on their heads, and wooden shoes on, which give notice, of a 
cold morning, by the clatter while they approach at the distance 
of a square. Where potatoes are used almost as much as in Ire- 
land, but of inferior quality, and rye bread alone, or as an ad- 
juvant to potatoes or beans, does not much improve the food. 
We were informed that those who can procure the flour bake 
once a year, others semi-annually or quarterly, according to 
ability to provide. The family of the present writer saw our 
landlord, at the best hotel in Gotheborg, dining upon potatoes 
and salt, after the viands, which were left at our dinner, had 
been removed. The manner of making their rye bread does 
not favor ks digestibility — all we saw of it was made after the 
fashion of the passover bread of the Jews, and looks to be 
dried, rather than baked ; nevertheless, it is reasonably palat- 
able, but, we would say, inferior to the potato of the growth of 
the Irish soil. In the houses of the rich we see buns of the 
most beautiful wheat flour, and well made ; but even here you 
get a portion of the national bread to nibble at, while your 
plates are changing. We have a remark or two to make re- 
specting the poverty of living of the lower orders in Sweden, 
and then we shall drop this notification. Capt. Dunbar told 
us he had seen an old woman in Gotheborg, who had come fifty 
miles by w T ater, with a single fish for sale, of extraordinary 
size; but it would bring but a poor return for so long a journey. 
We saw quite an old woman in bed in the hospital at Gothe- 
borg, smaller and leaner than any other woman we had seen 
in that country. Her right forearm had been fractured in two 
places, and the middle fragment stood almost directly across, 
or nearly at a right angle with the upper and lower fragments. 
We saw it had been long healed, and, on inquiry of the physi- 
cian, who graciously conducted us through the institution, we 
were told by the humane incumbent, that he had admitted her 



REMARKABLE EPIDEMIC IN 1804. 215 

to save her from starvation, as the arm totally disabled her 
from laboring for her support. We shuddered at the sight, 
and reflected with wonderment how a rational creature could 
fall under such a disgusting bereavement. Had she had any 
sagacity to let her arm hang at her side, or upon a pillow or a 
board, no such deplorable deformity could have taken place. 

The report continues speaking of a place called Lilla Edit : 
"Here, as in other places, it was remarked, that many persons 
whose bowels had been habitually constipated for years, became 
perfectly regular in their evacuations, during the prevalence of 
cholera, but when the pestilence ceased, their bowels again be- 
came inactive." What does this signify? Does it lean towards 
the contagiousness of cholera. Does it not rather strongly in- 
dicate the presence of some new element in the atmosphere of 
that location at that time ; and is not this opinion strengthened 
by the cessation of the altered condition of the air in which those 
persons breathed ? To our apprehension, a stronger proof of 
non-contagiousness could not be found. Surely, the infection 
transferred from one person to another could not have given 
existence to a new condition of the bowels of certain persons. 
Then what was it ? Why, what was malaria to others, was 
sanative air to those who were thus affected at Lilla Edit, and 
other places ; they only enjoyed its comforts, and they " were 
many." We have seen but one well-marked instance of altered 
bowels, in the person of a lady of unquestionable veracity, 
who was in feeble health for a long time before this strange 
affection : upon her weak bowels during one of the severest 
cholera epidemics that we have seen, habitual looseness gave 
way to regular action. 

Among the reporters to Dr. Berg, we have the name of Dr. 
Ekegreen. We notice among the doctor's observations the 
following : " Whatever difference of opinion there may have 
been regarding the efficacy of measures of shutting out the 
cholera, all seem agreed as to the advantage of shutting the 
disease in where it has made its appearance in a house, whether 
in a village or in the country." Indeed ! has the cholera be- 
come tangible in Sweden? Have we the power and the choice 
to let it in, or turn it out? Admitting the notion of contagi- 



216 EPIDEMIC CHOLERA. 

ousness of the malady, how can we shut it in in infected 
houses? Whether the patients live or die, communication must 
be held with persons who administer to their wants. To us, 
there seems to have been a strong delusion existing among Dr. 
Berg and his colaborators, in giving so decided a habitation 
to a thing which, so far as we can discern, is quite occult ; and 
as we believe is neither to be barred or debarred in or from 
our houses. It appears now here, now yonder, and never 
abides longer than a few weeks in one place in great force. 
In Sweden it appeared in 1834, and ceased in a few weeks, 
and did not show itself again till 1850. Why does it cease in 
cities, towns, and country places, where no measures of pre- 
vention by seclusion were used for that purpose ? Before the 
reporters can justly hope to establish their opinion, it is in- 
cumbent upon them to show, that, as they all set out with the 
belief of the infectiousness of cholera, the epidemic, by their 
measures (prophylactive) in shutting in and shutting out, ought 
to have lessened the number of cases, and of course its mor- 
tality, and shortened its term of domiciliation ; but as far as 
we can discern, speaking of its totality in Sweden in 1850, 
they fared no better than places where no attempts were made 
at seclusion, or delusion propagated; so, that while nothing 
useful was obtained by fighting against morbific shadows, 
much evil necessarily arose from the enforcement of sanitary 
or seclusive efforts. When we can " ride on the whirlwind and 
direct the storm," we may hope to rule the anti-hygienic con- 
dition or principle which modifies our atmospherical diseases, 
that are known to have existed from the days of Hippocrates 
at least ; and are held to be the offspring of malaria of different 
kinds. 

We have now gone through the principal details, or what 
may be termed the narrative of Dr. Berg's Reports, intent 
only on finding out the truth — we do not mean the truth as 
regards the supposed facts, but the true nature or character of 
epidemic cholera; and it will be admitted, we think, by most 
medical readers, that whether cholera is propagated by a new 
element or principle in the air, or dispersed from one place to 
another by personal infection, there is but one choleraic poison. 



REMARKABLE EPIDEMIC IN 1804. 217 

We feel no vanity on the subject, but our opportunity has been 
ample, and we do not reason on, or narrate matters of fact 
from those who were employed to collect information for us, 
as was the case in Sweden. Although we consider the charac- 
ter of cholera to be open to inquirers in general, we hesitate 
not to declare as our settled conviction, that there is but one 
predisposing cause or agent which can produce epidemic 
cholera, and that needs no medium of conveyance from point 
to point, because the primary element has the quality of 
ubiquity. 

However important and however praiseworthy the knowledge 
which has been attained by modern investigation in pathology, 
and perhaps no one more lightly appreciates such knowledge, 
we still think, the discovery of Sydenham, and the lucid man- 
ner in which he presented it to us, has lost none of its impor- 
tance, or is in any degree disrobed of its brilliant- vesture, nor 
more brilliant than well fitting the majesty it envelopes. To 
us it seems that however well the study of medicine may be 
entitled to the character of a science, still it is beset in all its 
multifariousness, with things occult and things uncertain; and 
often w T ith things unfixed. Such, the characteristics of medical 
science, and medical lore and inquiry, no wonder that our les- 
sons are hard to get, or that investigators shall differ ; but, 
although the intrinsic nature of the anti-hygienic condition of 
the stratum of air in which we breathe, is subject to semi- 
occultness, still its presence and its rule is as manifest as that of 
electricity, apparently the prime motor of all secondary things. 
This is the agent which beautifies the forest and the fields 
with their verdure, gives robes to the fishes and the fowls ; and 
all the gaudy vesture of the birds, even to the tints of the 
feathers of the latter class ; also exerts its power upon things 
the most minute. This great power dwells in the vaulted 
heavens over our heads, and when things below languish, comes 
down in robes of fire, and in exuberant power explodes with a 
force immeasurable. There is a principle or power which, 
though ever active, and although obedient to man's devices in 
calling it from the clouds by a simple kite, and making it the 
messenger to parts far off, still it has the quality of ubiquity ; 



218 EPIDEMIC CHOLERA. 

and this principle it is we opine that rules the air we breathe, 
and gives existence to morbific cycles which rule our diseases; 
among which we believe now stands epidemic cholera, and this 
cycle so formed, has existed in the United States since 1832, 
and never before since the settlement of the country by white 
men. In the body of this work, we have endeavored to show 
that the cause of cholera has a binary quality. We have re- 
ferred to the supposition that the new cycle, which now exists, 
has the quality of impressing a new condition on the malaria 
which has so long been the cause of our summer and autumnal 
diseases. If we can only offer this opinion on supposition, it 
seems to us the most satisfactory explanation, and is corrobo- 
rated by the phenomena characteristic of electricity ; it is 
everywhere, in all things, still it has its gambols ; it dwells in 
the clouds; it is diffused over things on the face of the ground, 
yet it has its modifications ; diffusion is its every-day garb ; 
but, again, it has its flights of aggregation, and nought can 
then withstand its power. It seems to rule for our good by 
its general laws, but has its vagaries, and among these is the 
production of diseases and death upon all things, whether those 
that breathe through animal lungs, respiratoria of the lower 
orders, or the endosmose and exosmose of the vegetable tribes. 
We notice some discrepancies between the details, and " the 
able resume of Dr. Berg," so termed by Dr. Carlton. But to 
proceed : " In 1834, the pestilence advanced on the eastern 
coast, near thirty Swedish miles further to the north, and 
Gotheborg among the rest suffered severely. From Gothe- 
borg, in 1834, the disease spread in a northeast direction, as it 
did in 1850, following the course of traffic along the Gotha 
River up to the great Werner Lake. Besides the capital, 
Stockholm, eighteen other provinces were affected in 1834 ; 
but Malmo and Gottland escaped." We have here to remark, 
that on the same page where the above assertion is made, we 
read, "in 1850 it lingered long in Malmo, an outlying spot, 
with but little trade." In the details as given by Dr. Berg, 
we read, speaking of the cholera of 1850, " Malmo is one of 
the ports of Sweden which has the most frequent communica- 
tion with Germany ; here the steamboats from Lubec and 



REMARKABLE EPIDEMIC IN 1804. 219 

Travemunde land their passengers, and an almost constant in- 
tercourse is kept up with Copenhagen." It has been seen that 
Malmo escaped the cholera in 1834, but in 1850 it was sup- 
posed to come from Liibec, and lingered a good while. How 
shall we reconcile the assertions that, as noticed in the details, 
that city was a port having free intercourse with Germany and 
Copenhagen ; but in the resume', it is an outlying port with 
but little trade ? How happened it that we are told in a note 
that " in 1834, the port of Skanor, distant half a Swedish 
mile from Malmo, was ravaged by cholera?" How did it get 
there, while Malmo, having free steamboat communication 
escaped ? 

The deaths from cholera in Sweden in 1850, were 1761, 
and of these 378 died in Malmo, said to be "an outlying port, 
having but little trade;" so that the mortality in Gotheborg, 
and all the long conduit of the Gotha River, and its radiating 
lines to towns and country, and canals, and lakes, affording 
the media through which the vast trade, making the very heart 
of Sweden as regards intercommunication, is scarcely four 
times greater than that of the humble town of Malmo. To 
our apprehension, this fact gives but little support to the sup- 
position, that choleraic infection is more potent than even 
small-pox, if we give credence to the belief that a man may, 
by almost a momentary exposure, be overtaken the next day 
with a deadly disease, and die in a few hours. We have to 
take into the account of the mortality of 1850, towns, islands, 
&c, between Malmo and Gotheborg. This seems to be a 
proper place to repeat what we have elsewhere written, — that 
in the United States cases of cholera have existed in many 
parts sporadically, endemically, or epidemically, and in its in- 
troduction, epidemically only in periods of the year when dis- 
eases the offspring of miasm were wont to prevail. 

According to our judgment, the most imposing appearances 
of the Swedish Reports is, the apparently long chain of co- 
incidences in the things seen ; but we may remark that co- 
incidence, is by no means, always proof of identity or correla- 
tive affinity. In matters of this sort we must compare things 
with things in other places ; and even then, we are not safe in 



220 EPIDEMIC CHOLERA. 

coming to conclusions, till we have our opinions verified by 
experience. The reports before us tested in that way, will be 
found not to quadrate with what has been seen in other coun- 
tries. But especially, we must not forget that, however long 
the chain of alleged transfers of personal infection, the whole 
resolves itself into a single one. In the question before us, a 
single instance will intrinsically decide it — if one instance of 
transfer occurs, such will be the nature of all the rest of at- 
tacks. Here, again, we must compare the grand whole with 
totalities in other large places, and bring into the investigation 
all correlative things — relationship with other diseases, an- 
terior to, and contemporary with cholera, as well in relation 
to symptomatology as to curative means : and, however little 
reason we have to be satisfied with our success hitherto, we 
deem it highly important to bear in mind, that cholera, like all 
dangerous diseases, is now entonic, and again atonic, and of 
course is to be treated accordingly ; bearing in mind, more- 
over, that this state of things obtains both sporadically, and 
also epidemically, the former much the most commonly ; and 
as far as we have seen, all the epidemics were instances of the 
entonic cast, and to be treated as such. It is true that after 
the malady has disturbed the natural functions to a certain 
degree, which can only be judged of at the bedside, prostra- 
tion and real exhaustion exists to an extent which leads to 
fearful mortality, under every treatment that has been tested; 
but there is a culminating point in dangerous cases, whereat 
sedative measures dare not be used, and here almost uni- 
formly, stimulants will succeed but little better than sedatives, 
if at all. But of the strange things attached to the medical 
treatment of cholera, nothing seems so strange as that it has, 
almost everywhere, been treated empirically; all look for some 
nostrum or specific ; but we have already noticed this truly 
important branch of our subject. 

In concluding our examination of the Swedish Reports, we 
may remark, that we cannot divest ourselves of the impression 
which was made upon our mind, that the several writers of 
those Reports seem to speak with some point, on the mortality 



REMARKABLE EPIDEMIC IN 1804. 221 

wherever they believed thej had proof of personal infection ; 
on the other hand, they exhibit evidence of candor in ascrib- 
ing the more or less extension of cholera to impurity of the 
circumambient air, as deteriorated by locations, small and 
filthy houses, in short, by whatever usually gives rise to ordi- 
nary miasm ; but, if there be virulent infection generated in 
the bodies of the sick, why should we look for anything else 
for the generation of cholera ? Upon a cursory notice of this 
compound cause, it may seem that it matters but little, whether 
there be animal infection, or, whether we suppose it to be in the 
air; but a closer scrutiny shows us that there is no animal 
infection. All the restraints and privations to keep the sick 
from the well are replete with evil, hardships, and delusive 
proceedings, that greatly interfere with the things of the poor, 
for among the poor, i. e. in their household affairs, &c, will be 
great distress, and this added to great fear, which will always 
be excited by the announcement of contagion, will be seen 
to increase the number of victims of attacks, and add to the 
number of deaths. 

The view which we take will give far less alarm, will lead to 
greater vigilance in nursing the sick, and to know or believe 
that there is a principle in the air of mild bearing, in general, 
which governs attacks, but capable, under peculiar circum- 
stances, of becoming highly dangerous or destructive, is 
less alarming. But, believing, as we do, that wherever a great 
epidemic is approaching, so to speak, by arresting associated 
harbingers, or in other words, the mild forerunners associated 
with cholera (i. e., bowel complaints), the people will strive 
against the true enemy, and not fear its approach, because 
whatever is seemingly tangible will give rise to more fear than 
things that are not seemingly tangible. We admit, however, 
that under all the aspects in which we can place this subject, 
we owe the truth and nothing but the truth to all who look to 
the medical profession for guidance and relief. 



222 EPIDEiMIC CHOLERA. 



EPIDEMIC CHOLERA AT COLUMBIA. 

In our examination of the reports of Dr. Berg, of Sweden, 
we promised to give a remarkable instance of an outbreak of 
cholera, at Columbia, Pennsylvania, in 1854, in which the cir- 
cumstances attending, conclusively prove the disease to be non- 
contagious and non-infectious. We visited Columbia three 
times during the presence of the disorder, and saw specimens 
of cholera in its several stages, of cholerine, cholero-dysentery, 
and cholera lethalis. But we have already so fully discussed 
the character of cholera, and the medical treatment of it, that 
we shall only incidentally drop some brief remarks, as we 
proceed to give a true account of everything associated with 
the visitation, both with respect to the locality, and the special 
character of the pestilence. 

Let us then turn our attention to things appertaining to the 
locality. The town of Columbia is situated on the Susque- 
hanna — the river immediately opposite, being one and one- 
fourth mile wide ; and just opposite to the present south limit of 
the town, there is a dam across the river, which at low water 
can be made to pour all its water into a tide-water canal, so far 
from the bay as not to be influenced by the tide of the Chesa- 
peake, into which it empties — and the damming of the water 
arrests the current of the water at times for a distance not 
less than the width of the river, so that there is a square area 
of one and one-fourth mile of still water surface. The sum- 
mer of 1854 was warmer than usual, and the river was lower 
than it had been for many years, and water-grasses grew 
luxuriantly throughout the dam, floating on the water for 
weeks under a burning hot sun, and to this we may add, that 
the dam would necessarily give rise to large quantities of 
deposits coming down the stream, among which it was said 
were a few dead sheep, not sufficient in our opinion to have any 
influence. 

There is a street running parallel with the shore of the 
river, and from this street, having houses only on one side, 
there is passing off several streets at right angles with the 



EPIDEMIC CHOLERA AT COLUMBIA. 223 

shore, in which the ground rises by a pretty considerable 
ascent. The street along the river is perhaps one hundred 
yards from the low water line, and this space is occupied in 
greater part by lumber ; but the piling of the timber, and the 
face of the ground is kept in good order, as far as we have 
seen. A little distance above the town relatively to the river 
current, there is a large basin, where there is a considerable 
pool, in which the water previously to the outbreak of cholera 
had a greenish surface ; and it was alleged that the use of 
this water had a share in the production of the pest, but we 
were informed by Dr. McCorkle, who is a native of the town, 
and highly respectable in his profession, that part of the town 
is entirely dependent upon pump-water, and that there was 
quite as many cases of the disease where the pump-water was 
drank, as where it was used from the hydrants which furnish 
the water from the pool. 

We have now to speak of things appertaining to the epi- 
demic. We recently visited Columbia with the view of getting 
the most correct information that could be obtained from 
reliable sources ; the disease being ended and opportunity 
had to view everything calmly, and without prejudice, or undue 
excitement. We shall now notice everything we met with, 
adverse to our opinion, in respect to contagions. A very 
respectable citizen informed us, that an emigrant family, man 
and wife, and one child, arrived in the Philadelphia cars — the 
man and child having the cholera upon them, both died; it 
was said the woman had the disease afterwards, somewhere in 
the West — they were taken to the upper end of the town and 
near the river, being thus placed almost out of the town limits, 
but they were visited by a number of persons ; and an attempt 
was made to magnify this circumstance, as having been fol- 
lowed by several of those visiters having been overtaken with 
the cholera ; but here two gentlemen of equal respectability, 
and who resided near where the sick family lay, promptly con- 
tradicted this report. Of those who were known to have been 
there, one physician, Dr. Cochran, of high respectability, died 
of the disease. Then our informant went on to tell us that 
five hundred sheep had been drowned and floated down into 



224 EPIDEMIC CHOLERA. 

the dam of which we have spoken, and thus was a mass of 
putridity accumulated, and thus was the epidemic produced — 
here again, by reference to the Spy, a very respectable news- 
paper published at Columbia, it was seen that those sheep had 
not been drowned till two or three weeks after the appearance 
of the cholera. 

This seems a proper place to notice, that although we visited 
Columbia three times during the epidemic, and had free inter- 
course with the most respectable citizens of the town, several 
of the physicians of the town and from Philadelphia, we did 
not hear one word about the emigrant family ; and there 
appeared to be one opinion with the inhabitants, that the dis- 
ease was occasioned by the effluvia from the great river-dam. 
We do not doubt that emigrants arrived having cholera, but 
the notion of contagion is an after thought. 

The above paragraph contains all the assertions respecting 
things supposed, by a few persons, to give support to the belief 
of choleraic contagion. We were informed by gentlemen whose 
veracity could not be questioned, that cholera had occurred 
in two women in the last week of July, so well characterized 
as to be implicitly relied on. We were furnished at the office 
of the Spy, with this notice — "Last week of July, two cases 
of cholera occurred, on Front street, above Locust ; the cases 
were women, and the house occupied by them a mere shanty, 
and very filthy. One of the women was intemperate, and 
occupied a room over a filthy sink. At this time there was 
considerable excitement—sanitary measures were resorted to, 
and no other cases occurred." Here, then, is cholera in the 
last week of July, to which must be added a general pre- 
valence of intestinal diseases, in the stages of cholerine and 
cholero-dysentery, or what has usually been termed diarrhoea 
and dysentery. How then will these facts quadrate with the 
supposition, that an emigrant family, who arrived on Thursday, 
the 7th of September, a period of nearly five weeks after two 
cases had produced much excitement, and worse still for the 
supposition that the stranger family brought the disease ? 
They were taken with the disease into a remote part of the 
town, where the man and child died. The travellers arrived 



EPIDEMIC CHOLERA AT COLUMBIA. 225 

on Thursday; the next day one of the citizens died; on Satur- 
day, 24 deaths occurred from cholera ; on Sunday, 25 ; Mon- 
day, 10; Tuesday, 10; Wednesday, 13; Thursday, 4; Fri- 
day, 9 ; Saturday, 6 ; Sunday, 4 ; Monday, 4 ; Tuesday, 5 ; 
Wednesday, 5; Thursday, 1; Friday, 3; Saturday, none; 
Sunday, 2. 

Can any man of common sense believe that a person, arriv- 
ing and dying of the cholera, could have disseminated from 
his body an invisible poison, that produced twenty-four deaths 
the next day, and twenty-five on the second, and so on, to 
occasion one hundred and fifty deaths in fifteen days ? but we 
may note particularly, forty-nine deaths in about forty-eight 
hours. It may now be said, that so far as cholera lethalis was 
concerned, the disease soon lost its epidemic character; for, 
but a death or two occurred on each day, after eight or ten — 
but about one hundred more victims fell before the pest. Can 
common sense possibly reconcile the facts, that a disease could 
pass diagonally several squares of the town, or in many different 
parts of the town, and produce not only seizures, but deaths 
numbering forty-nine, in about forty-eight hours ? these forty- 
nine cases were scattered over the town ; but most of them 
occurred in the streets the ends of which were presented to 
the river. 

What is to be said of what has been seen, according to the 
opinion that the emigrants brought the choleraic contagion ; 
and after the destruction of about one hundred and fifty per- 
sons, in two weeks, the contagion suddenly dropped its preroga- 
tive, and ceased to seize or slay ? Are we not warranted here 
in believing that the malaria from the river had its rise, its 
acme, and its decline ? Why did it decline from the epidemic 
condition in a few days, and gradually assume the sporadic 
condition? Simply because the morbific material had been 
exhausted, and now again was to be seen cases of cholerine, and 
other cases wearing the aspect of ordinary bilious fever. 

On Friday afternoon, 9th of September, a high southerly 

wind blew over the river into the town. On that day there 

was one death from cholera, which, no doubt, originated, as did 

that of the two women who died in the last week of July. The 

15 



226 EPIDEMIC CHOLERA. 

next day, Saturday, there were twenty-four deaths. These 
deaths occurring so soon after the deleterious gale of wind, 
strongly supports the opinion, that there is a prevailing cho- 
leraic cycle which rules every case of cholera. This view 
enables us to establish the belief that the immediate cause of 
the cholera was a poisonous air from the river ; and it was 
remarked, that on those days that the wind came from the 
river to the town, the cases were increased ; but on those days 
the wind blew from the town, that is, northerly winds, to the 
river, there were fewer deaths. This may, however, be acci- 
dental, and here, again, is proof that there is a prevailing sus- 
ceptibility, ever ready to be roused up, which is antecedent to 
cholera outbreaks. 

On the 14th of September, there was a rain, and one up 
the river, that raised the water sufficiently to carry it over the 
breast of the dam, and covered much of the water-grass ; and 
this was supposed to have abated the cholera ; but this disease 
generally comes, in its greatest force. 

Columbia has a population of about 5,000, and it is believed 
by those who had good opportunity to know, that at one time 
about one-half, perhaps more, of the citizens had left the town. 
The terrors of Saturday, 9th of September, set the people 
into motion, and many left town. On Sunday the number was 
greater; on Monday much greater. Of those who removed 
to some distance, four or five were known to have died of 
cholera; but there was no account of any one being infected 
by those who died abroad. The amount of mortality was con- 
siderable ; but we may remark here, that the greatest number 
of deaths occurred before many of the citizens had left town ; 
but still the progress of the disease shows that the onset of the 
disease was, decidedly, its stage of greatest severity ; and it is 
proper to remark here, that we were assured by reliable autho- 
rity, that of those who were carried into the stage of cholera 
lethalis, or collapse, not more than two or three recovered. 

There is reason for believing that the piles of boards and 
lumber, which we have noticed, had a retarding influence, by 
arresting the floating effluvia ; and this accounts for there being 
more cases in streets whose ends, next the water, were more 
ready recipients of the malaria. We were informed that, in 



EPIDEMIC CHOLERA AT COLUMBIA. 227 

one place, where the lumber stood thick, there were fewer cases 
than in other streets, particularly near the river. The ascent 
from the river is considerable, but we do not know the greatest 
altitude. The disease was as common, and as fatal, on an 
upper stratum as on the lower. We have already referred to 
the observations made in London, upon different strata, by 
which it appears that strata, of given levels, will be found to 
suffer less by cholera as we ascend. In the case before us, 
everything seemed to conspire to carry the poisonous air 
along, and the streets into which the wind blew almost in a 
direct line. We can readily believe that a poison held in the 
air of a lower stratum would be driven by the puffs of a gale 
of wind, as we see drifting snow propelled onward, by puff 
after puff, sending it forward. Indeed, we do not see how 
else the poison could reach higher points of the town. How 
shall we imagine that a poison shall rise from a comparatively 
cooler and denser medium, and ascend to the height of, per- 
haps, fifty feet, and not become diluted, and here dilution 
would doubtless abate the virulence of the choleraic poison ; 
and if we might suppose, that if it produced cholera, the form 
of the malady would be the same ; but admit this, and we 
must, we think, also admit that there will be fewer attacks ; 
if this were not the case, we might reasonably suppose all visi- 
tations of the epidemic would be nearly alike. 

Our main purpose in offering this account of the cholera at 
Columbia, is to show that the things seen appertaining to that 
outbreak, are utterly irreconcilable with the belief of cholera 
contagion. What we have written may well convince any one 
who is open to conviction, that contagion of a personal charac- 
ter could not have had any influence ; and the idea, that the 
same sort of infection can be produced or originated by the 
effluvia of a river, and also, by elimination from the human 
body, is truly preposterous. We deem it proper, however, to 
notice a few more facts bearing on the subject of our present 
inquiry. Some of the humane and respectable citizens devoted 
much of their time in kind offices to the sick, and were con- 
stantly exposed. Had there been any contagious effluvium 
about the sick, they must have suffered. We made three 



228 EPIDEMIC CHOLERA. 

visits, and each time spent several hours among the sick and the 
dying ; we were frequently in the hospital, where there were 
several patients, whom we carefully examined ; and, on one 
occasion, sat an hour and a half in the presence of the sick, 
and as we had no fear of contagion, so neither did we suffer 
any injury. 

The epidemic at Columbia was one of the severest visita- 
tions that has occurred in this country, and excited the atten- 
tion of the physicians of Philadelphia, and as many as ten or 
twelve visited Columbia during the epidemic, and bestowed 
their attentions upon the sick fearlessly. A meeting of physi- 
cians was held on the 12th of September, for the purpose of 
giving some instructions to the panic-stricken and suffering 
citizens. The following is a report of the proceedings, but 
we may remark here, that all the gentlemen had but one 
opinion as to the character of the disease, but their treat- 
ment was peculiar to each of them. 

On the 9th of September, Dr. Jewell and Dr. R. La Roche 
arrived at Columbia, from Philadelphia, from motives of hu- 
manity ; but under the auspices of the College of Physicians, 
a meeting of physicians was announced, and took place the 
same afternoon, when the following proceedings were had : 

Rules to be adopted by the citizens during the prevalence of 
Cholera. 

1. Give prompt and early attention to any looseness of the 
bowels, or diarrhoea, by lying down immediately, and send for 
medical advice. Looseness of the bowels is the beginning of 
the disease. 

2. Do not become alarmed. Fear will often produce the 
disease, which, when treated early, can in nine cases in ten be 
cured.* 

3. Cholera is not contagious ; that is, there is no danger 
from handling or going near to persons having the disease. 

4. Use freely chloride of lime in your houses, cellars, yards, 

* In the choleraic epidemic in 1832, not one in several hundred died, and 
we do not consider this an uncommon instance. 



EPIDEMIC CHOLERA AT COLUMBIA. 229 

and in every place that is foul, by wetting it, and distributing 
it in plates about the premises. 

5. Live temperately. Avoid the use of .alcoholic drinks en- 
tirely. Keep good hours — avoiding the night air, and the 
early morning dews, as well as crowded assemblies. 

6. Keep the body clean, and the mind free from all excite- 
ment. 

7. Give notice early of any sickness in your family, that 
immediate attention may be given to it by your physician, or 
by the proper authorities. 

8. Whitewash your cellars, shops, alleys, fences, and keep 
your houses clean and well aired. 

9. Avoid eating unripe fruit, or indigestible food, and every- 
thing else that will in any way tend to produce looseness of the 
bowels. 

10. Do not keep any dead animals, or decayed meats, or 
stale oysters, or spoiled potatoes, or other decaying vegetables, 
about your premises. Have them removed at once, covered 
with chloride of lime, or buried. 

The above rules were adopted at a meeting of the physi- 
cians, held at Col. Herr's, this afternoon, and recommended 
for the government of the citizens, during the prevalence of 
the epidemic, believing if they are strictly adhered to, that 
the disease will be mitigated, and many cases of sickness and 
death avoided. 

Drs. Wilson Jewell, R. La Roche, College of Physicians of 
Philadelphia. Dr. H. G. Jameson, Sen., Professor of Surgery, 
then of York, Pennsylvania, now oft Philadelphia. Drs. L. D. 
Bodder, Elwood Wilson, Henry Hartshorne, Thomas Spencer, 
J. H. Jackson, W. F. Atlee, of Philadelphia. Dr. Har- 
ris, of Harrisburg. Drs. W. S. McCorkle, L. S. Filbert, A. 
C. Smith, D. S. Bruner, D. J. Johns, 0. S. Mahon, J. Chester, 
of Columbia. 

Approved and strenuously recommended by the Town 
Council. 

J. M. Watts, 

September 9, 1854. Chief Burgess. 



230 EPIDEMIC CHOLERA. 

Most of the gentlemen above named were in attendance on 
the sick for several days. Some of them examining and pre- 
scribing for cholera patients for more than a week ; and were pre- 
sent with the dying and the dead. We heard of but one dis- 
section, which presented nothing new — turgescence of the brain 
most remarkable feature of the post-mortem, and most patients 
presented redness of the eyes and other symptoms of involve- 
ment of the brain. 

Now, in the name of all goodness, how shall we allow our- 
selves to believe, that the most trifling exposure in Sweden, 
as reported by Dr. Berg, — such as sitting a few minutes beside 
a sick person ; talking to a man in the open air, but who was 
not yet affected by the disease ; lying down for a short time 
in a bed where a person had died of cholera ; or being present 
a brief period where some clothes were opened that had been 
left by victims of cholera ; and of a man coming from a place 
infected, giving it to his two children, not having it himself; 
for, we are obliged to admit the truth of the above as stated, 
of so many physicians being exposed in every possible way, 
with impunity. We have been informed since writing this 
clause, that Dr. Atlee had the disease after leaving Columbia. 
He was as much exposed as the citizens, then why not liable ? 
Where is there room for doubt of the absence of contagion, 
after seeing the mass of information, of a similar kind to that 
seen at Columbia and other places, as it has been recorded in 
the body of this work ? 

We have elsewhere advanced our opinion advocating the 
belief that cholera strongly resembles our summer and au- 
tumnal bilious fevers. In corroboration of this opinion, we 
may remark that, Columbia has always been subject to a pretty 
full share of- the miasmatic diseases that infest the shores of 
the Susquahanna ; and, although the things which are every- 
where acknowledged as the cause of intermittent and remittent 
fevers were present in greater degree than usual, there was 
comparatively very little of such fevers, though there was some 
blending of bilious fevers and cholera; but, a portion of the 
former were in the garb of cholerine and cholero-dysentery. 
Still more strange, Marietta, a small village three miles from 



EPIDEMIC CHOLERA AT COLUMBIA. 231 

Columbia, up the river, was severely scourged with their usual 
autumnal fevers ; but, there was no cholera acknowledged, and 
of course, there was none. Fevers prevailed along the river 
shores, in the several towns and villages, and farm-houses, but 
cholera was not acknowledged. Miasmatic diseases prevailed 
early in the summer at Columbia. 

On the 15th of September, Mr. Samuel Heuston arrived at 
York, Pennsylvania, quite ill with symptoms of cholero-dysen- 
tery, under which he had been laboring during the time that 
cholera was at its height at Columbia ; and, he had been living 
in Locust Street, where cholera prevailed in as great a degree 
as in any other street, except one; he was somewhat advanced 
in years, had been in delicate health during the summer, and 
was now much prostrated. Believing in what was said by the 
body of respectable physicians who met at Columbia that, 
"looseness of the bowels or diarrhoea is the beginning of 
cholera," an opinion this, that we adopted in 1832 ; we believed 
that Mr. Heuston was afflicted with that affection in its stage 
of cholero-dysentery, for, this was the character of his case. 
We did not think proper to resort to cholera specifics, but with- 
out regard to the prostration of our patient, we prescribed an 
active cathartic ; at a single dose he took ten grains each, of 
calomel, jalap, and nitrate of potash ; this operated pretty freely, 
and brought away bilious stools, during the night, and in the 
morning he told us, he had never in his life found so much 
relief from a dose of medicine, as from the evening dose. We 
now prescribed a weak mixture of sp. nitre and antimony ; but it 
did not seem to afford any benefit, and we had to resort to the 
further use of mild cathartics, and in a few days our patient 
returned home, having nothing to contend with but debility, 
which soon wore off. We saw him some time afterwards in 
good health. 

On the same day that Mr. Heuston arrived came his son-in- 
law, Mr. Greene, affected seriously with cholera, in the stage 
of cholerine. He underwent nearly the same treatment, as 
related in the foregoing paragraph, i. e., in both these cases, 
we are confident that most physicians would have used reme- 
dies to restrain the diarrhoea ; we used active cathartic medi- 



232 EPIDEMIC CHOLERA. 

cine, and thereby arrested the advancing cholera, nor, do we 
believe that their speedy recovery was owing to their removal 
from Columbia, since it was now too late to expect direct 
benefit from change of air ; but, the period had not passed at 
which relief might be expected, from depleting from the alimen- 
tary tube, in close alliance or sympathy, with all the inroads 
of cholera lethalis. 

If the foregoing instance of outbreak of cholera, with its 
concomitant circumstances, does not establish the non-conta- 
giousness of epidemic cholera, nothing will, and it would be 
useless to argue the question. The cause is so manifest, the 
outbreak so sudden, and the proportional mortality so great, 
that the ensemble is satisfactory in a philosophical view, and 
affords one of the clearest specimens of the character of epi- 
demic cholera that has occurred in the United States. But 
we shall continue our remarks somewhat further. 

We think it will be admitted, that the question, whether 
cholera be contagious or not, is one of great importance, and 
we have endeavored to investigate, and show the non-conta- 
giousness of the malady; but the exhibition of the circum- 
stances which were present at Columbia, have convinced our- 
selves beyond doubt, if we had not been convinced before : 
indeed, we would contend that there is one circumstance which 
should alone decide this question. Cholera, like all other 
specific disorders, can have but one cause, and is, therefore, 
in all places and at all times contagious, or in all places and 
at all times non-contagious. What shall we say, then, about 
an unlucky arrival of an emigrant family just at that juncture 
of time when the disease was about to break forth ? 

A careful investigation into the circumstances attendant on 
the outbreak will, we think, afford a strong — we were going to 
say argument, but we shall take a stronger ground ; and say 
that if we cannot here draw a positive conclusion, there is not 
a single platform in medical science whereon to stand fast. 
Let us see. There were two cases of cholera in July — from 
whence were they derived? The malarious condition of Columbia 
stands high in the scale of malarious localities ; the visible ma- 
terial which yields miasm was in unusual force : low water, hot 



EPIDEMIC CHOLERA AT COLUMBIA. 233 

sunshine, exposed water-grasses, a southern gale of wind, and 
a simultaneous attack of cholera lethalis, in several streets on 
the same night of the gale ; and also a simultaneous change of 
the prevailing diseases. With all these circumstances, and, 
we have added thereto, the universal predilection, so to speak, 
which cholera has shown for like localities ; and who will gain- 
say the declaration that cholera is not contagious ? 

But, say the contagionists, several persons who visited the 
emigrants while sick fell victims to the disease. Here it really 
seems, that these contagionists not only insist on all cases occur- 
ring while visiting the sick are cholera ; but, they really re- 
quire for the admission of non-contagiousness, that no person 
who visits or nurses a patient shall take the disease, no matter 
how many absent from the sick in the same town or district shall 
take it. Others took it out of doors ; and, many contagionists 
admit from atmospherical poison — then why not place all on 
the same footing ? Those about the sick are not exempt from 
the epidemic influence no more than those out of doors ; yet, 
if one sickens within, and some twenty or a hundred sicken 
without, many, even medical philosophers, will say, " See the 
proof — the nurse took the disease ; it must have been caught 
from the sick." And besides that the nurse has as much chance 
to take the disease in the common way as he whom he nursed, 
he is supposed by contagionists to take the malady from a per- 
sonal poison ; — here, then, is a double chance for the disease ; 
one outside like other people, another inside. Do not most con- 
tagionists who admit that there is an atmospherical cause, and 
also one personal, throw themselves into this dilemma ? And 
if this were a correct view of the subject, he who nurses in in- 
fected districts or towns, must be doubly subject to the disor- 
der. Verily, the nurse, according to this supposition, must live 
in great peril ; and how much better would be the case of phy- 
sicians ? and, yet, they certainly do not suffer in greater degree 
than other people. 

The reports of Dr. Berg, of Sweden, noticed in this work, 
are in a great degree devoted to showing how the cholera fol- 
lowed the courses of trade in that country, and we have a 
labored account of the mode and means by which the contagion 



234 EPIDEMIC CHOLERA. 

passed in the exact course of the trade, along water-courses. 
How then is it that no such thing occurred at Columbia? 
Wrights ville is a busy town on the river directly opposite to 
Columbia, and there was no cessation of intercourse : people 
passed and repassed daily ; and we saw one of the physicians 
of Wrightsville in Columbia during the height of the cholera. 
Not one case of the epidemic occurred at the former town. 

"We have already noticed the fact that the appearance of 
the cholera in Columbia was attended with southern winds, 
which came across the great dam formed in the Susquehanna, 
and the northerly winds, while they abated the malady in 
Columbia, did not carry the pestiferous air to Wrightsville. 
Here is presented a thing inexplicable in the present state of 
our knowledge, but from the light which has recently been 
thrown upon what may be termed chemical electricity, there is 
strong probability that these anomalies which we now and then 
see, or which, indeed, may be said to be pretty common — we 
mean the occurrence of cholera in one town or district, while 
in another closely adjacent it is wholly absent — are owing to a 
double cause being absent. 

It does not seem desirable to go into speculation on this 
point of our subject, but it may not be amiss to make a sug- 
gestion or two. Whatever may be in other countries or places, 
in the Middle States of our Union, thunderclouds rise in the 
northwesterly direction, and move more or less southeasterly ; 
for this there must be some law. It has long been known that 
the lower stratum of our air is constantly varying its quantum 
of the electrical principle, clear, frosty mornings filling the 
hair of our domestic animals with electricity to repletion, while 
in damp weather with south winds, the old-fashioned electri- 
cal machines can scarcely be excited. 

When we add to this, and much more that might be said, 
how electricity can be, so to speak, brought into fixed com- 
bination ; as in turning oxygen by it into ozone ; to say the 
least, it does not seem unreasonable to allege, that the appa- 
rent vagaries attendant upon cholera, are ruled by electricity. 

We may well suppose that cholera poison, like all visible 
things, has its rise, its acme, and its declination. From the 



EPIDEMIC CHOLERA AT COLUMBIA. 235 

suddenness of its assumption of the lethalic stage, and its early 
declination from- that stage epidemically in different places, we 
are led to believe that there is something like ebullition, i. e., 
new affinities take place between the elementary integers 
which form miasm, of a volatile or perishable compound na- 
ture : and the pestiferous product soon becomes extinct ; and 
in all these changes electricity performs an important part, as 
we see in the production of ozone. We must admit that there 
is some cause, and, what so likely to govern in these cases as 
electricity ? Whether it acts by the union of new matter, or 
by the withdrawal of something from the compound miasm, we 
will not attempt to surmise; but electricity is over all things, 
in all things ; it can control formation and life ; and it can 
destroy things animate, and things inanimate. 

We see the material before us that generates miasm ; miasm 
is said to be a modification of ozone ; ozone is said to be a 
modification of oxygen. Miasm generates our bilious fevers. 
A district or town is infested with these diseases, and presently 
the stomach and bowels become more than ordinarily involved ; 
and in diarrhoeas suddenly the disease assumes a new phase; 
cholera, that affected the people slightly and for a period with- 
out a single malignant case, suddenly assumes an aspect of 
mortality. Can we here doubt, that there has been a period 
of incubation ? and the process being accomplished, like burst- 
ing bubbles the poison becomes extinct, and is dispelled upon 
the winds in a short period of time. 

It may be that the same modification of the atmosphere that 
forms the choleraic influence, while it operates to the produc- 
tion of the choleraic disposition, may also operate upon the 
ordinary miasm, so as to modify that malaria which usually 
produces fall fevers. Common ratiocination shows us that there 
is a widely diffused choleraic entity, and the visitation in 
miasmatic localities of that disease, in the season that is wont 
to exhibit bilious fevers, shows that the common miasm is not 
present in its common character during the presence of epi- 
demic cholera. Again, cholera is seen to prevail almost uni- 
formly for some weeks in its mild garb ; this stage is acknow- 
ledged generally as "the beginning of cholera." Suddenly 



236 EPIDEMIC CHOLERA. 

we have a blow out of cholera lethalis : What can be the cause 
of this ? Surely there is some alteration ; not in the general 
atmosphere, as we may judge ; for this, as far as we can see, 
has been the same ever since the advent of this pestilence ; 
but cholera having assumed the place of miasmatic fever, shows 
that there is a change in the local malaria. If this be a fair 
exposition of the phenomena, it follows that there is a general 
cause ever the same, wherever recognized. We may also re- 
cognize a local cause presenting entirely new features, and we 
have a new disease. Have we not good ground for the opinion 
that there is not only a co-operation of those morbific entities, 
but a union of action ? and hence we derive our belief in the 
reality of the cause of cholera ; and this brings us to declare 
that there exists in its mild forms a grand atmospherical con- 
tamination ; but cholera lethalis or asphyxia arises from a 
compound cause, and this is what we term a dual cause — dual, 
because it comes under our recognition only where there exists 
a local choleraic entity, and it is only when this local morbific 
entity comes into affiliation that we have epidemic cholera. 



INFLUENCE OF ALTITUDE. 

We have elsewhere given some account of the cause of yellow 
fever operating in the lower stratum of the air, and the escape 
of people who resided above in health ; and there is such 
manifest similarity between the cause of yellow fever and the 
high grades of common bilious fever, that there is ground for 
believing that the ponderosity of the two will be nearly simi- 
lar, and as cholera appears oftenest in locations in which yel- 
low or other epidemic fevers sometimes exist, there is scarcely 
any room for doubt that the several forms of disease just 
noticed, are the offspring of a poison nearly akin. Indeed, 
they are sometimes blended, as we have already noted ; there 
can therefore, scarcely be a doubt, but that the fomes of 
cholera exist only near the surface of the ground ; and it may 



INFLUENCE OF ALTITUDE. 237 

be remarked, that in its malignant aspect it has mostly a 
shorter duration than yellow fever fomes. 

We entertained this opinion ever since the appearance of 
cholera in Baltimore, in 1832, and are happy to see it cor- 
roborated by observations made in London. (See London 
Lancet.) "It was discovered during the epidemic cholera of 
1848-9, in London, that the rate of mortality by the disease 
was nearly in the inverse proportion of the elevation of the 
ground on which the dwellings of the inhabitants stood. The 
same relation between the rates of mortality at different eleva- 
tions, though the deaths have been comparatively few, has 
been observed in the present epidemic (1854)." The account 
goes on to give the different elevations of districts, from twenty 
feet to a hundred, and at twenty the mortality was seventy-one 
in 100,000 inhabitants ; at one hundred feet the deaths were 
but three on a space equal to that of the first elevation. " At 
Hampstead, where the elevation may be put down at 350 feet, 
there has been hitherto no death from cholera." And the in- 
ference is drawn, " that the danger of dying of cholera, and of 
all plagues, diminishes within certain limits in proportion as 
the dwellings of the population are raised above the level of 
the sea." The present writer advanced this opinion at the 
meeting of the Medical Literati at Hamburg, in 1830, in rela- 
tion to yellow fever; and time and opportunity have served to 
confirm that opinion with us. In the epidemic of London, 
1854, the foregoing opinion has been confirmed in its fullest 
extent. 

We quote again from the London Lancet. " The mortality 
from cholera to 100,000 living at the three elevations, is 287 
at the lowest, at the middle 109, and 32 at the highest eleva- 
tion." With facts as our guide, we may generally safely 
rely on the conclusion to which they point ; but the history of 
the protean disease before us, is ever presenting new phases, 
so that here, as in most things characteristic of epidemic 
cholera, we may look for vagaries, but if we can rely upon 
this feature of the malady, we will have gained a point of 
much value ; and the prophylactics which may thence be derived 
are too obvious to need enumeration — people in all conditions 



238 EPIDEMIC CHOLERA. 

of life may avail themselves of prevention, by elevation, both 
in their houses and terrestrial locations ; and the removal of 
the people who occupy low houses, in low localities, will be 
more benefited by early removal at an outbreak, by putting 
them on higher grounds, than by endeavoring to smother it 
amid the filth and confined air, by measures of seclusion. 



OF THE CHOLERA IN PARIS— 1853. 

" The first case in Paris, occurred on the 11th of November. 
Since that time several other patients, male and female, have 
been admitted into the different hospitals. Moreover, there 
have been observed some cases disseminated in the 9th and 
11th arrondissements. Some died; others, when heard of, 
were in a dangerous state ;" and it is said — " Premonitory 
diarrhoea was a constant phenomenon." This phenomenon is 
of too much importance to be overlooked, and cannot be too 
much insisted on as being in reality incipient cholera, standing 
out as the harbinger of a near approach of a malignant 
stage — which stage can be warded off in almost all instances, 
and this gives support to the opinion which we have already 
advocated, that cholera is the offspring of a principle inherent 
in the stratum of air we breathe, and, though endowed with 
the quality of ubiquity, is unequally dispersed and incapable 
of generating cholera, except where it affiliates with some 
other effluvium, or morbific agent. If exceptions, in regard 
to these premonitory disorders of the primae viae, are now and 
then seen, this does not invalidate the general law, and we must 
call to mind here, that exceptions abound in the symptomatology, 
and in the treatment of all diseases changes are required ; if this 
were not the case, we might expect to reduce medical acquire- 
ments to a simple art — viewed as a science, we see constantly 
errating signs which baffle systematic codification. We aim at 
writing an American book, and, therefore, do not deem it neces- 
sary to call up anything peculiar to France, except the important 
fact of universal premonitory diarrhoeas in choleraic locations. 



ON THE USE OF COPPER IN CHOLERA. 239 



OX THE USE OF COPPER IN THE TREATMENT OF 
CHOLERA. 

Amid the necromantic modes of medication in cholera which 
has abounded in all countries, as though it were a spell to be 
arrested, or disarmed of its power by charms, we read in the 
London Lancet, of the power of copper as a prophylactic and 
as a medicamentum. This article never having been intro- 
duced into general use, we shall in noticing its remedial 
agency speak of it, as of all other remedies when used as 
specifics. Certain it is, that cholera is a disease so diversified 
in its phases, so erratic in its general character, that it must be 
treated in its individuality. There is variety in the symptoms, 
differences in constitution and habits of its victims — differ- 
ences in seasons, locations, idiosyncrasies; besides, the dif- 
ferent stages of the malady are so dissimilar, that no disease 
requires more care and skill clinically, than this protean 
disorder. 

So far as we recollect, the opinion that metals must be 
oxidized before they will dissolve in an acid, has not been 
denied, as advanced long since by Lavoisier. If this be ad- 
mitted, how is copper to act upon the human body, except by 
oxidation and suspension in the air, or through the medium of 
electricity ? Dr. Bury, the author of the metallic practice, 
denies that electricity has any agency in the case, but believes 
that it is hurtful wherever applied. This is a point not easily 
explained or decided, but it seems reasonable to attribute any 
influence which copper may be known to exert, to electrical 
influence. There is a similarity in the law governing elec- 
tricity and the choleraic principle — both are seen to have 
their special and localized operations, and yet are clearly en- 
dowed with ubiquity. It is due to Dr. Bury, to say that he 
tested, as he reports, the preventive power of copper, in 
Sweden, Austria, Russia, Turkey, and England, with great 
success as a prophylactic ; but in these experiments there is 
great uncertainty in making conclusions, for in a vast majority 
of instances in the localization of cholera, a large portion of 



240 EPIDEMIC CHOLERA. 

the populace will escape, or, at most come off with attacks, of 
more or less severity, short of the malignant stage of the 
disease. 



NOTICE OF THE EMPLOYMENT OF SULPHURIC ACID. 

In the London Lancet, we notice some remarks, which we 
deem remarkable, considering the high source from which they 
emanate. "Some have died with sulphuric acid, and others 
have recovered where the same remedy was used." This is 
no more than what we may expect in all diseases, whether left 
to nature or under treatment. " Calomel and opium, in small 
and large doses, have also given various results." In a disease 
so herculean when arrived at its acme, we can only hope to 
cure a small part of the sick, and the adaptation of remedies 
by our clinical skill is all we can hope for — still, there is conso- 
lation in the opinion, which we believe to be well founded, that 
those physicians who go to the bedside having little prejudg- 
ment, except a general store of knowledge appertaining to the 
disease and its sanatives, so far as known, will save more of 
their patients than by the empirical employment of this or 
that means. Such is our view of the subject before us, and this 
seems a proper place to refer to what is closely allied with 
practice by specifics, viz., that too much attention has been 
given to the fluids, especially the blood, to the neglect of the va- 
rious secreting apparatus. We feel well assured of the import- 
ance of the relative vitality of the blood, and that this is the 
medium through which death may be said mostly to finish his 
work ; but even here there are exceptions. We have seen cases 
in which death came principally through the grand sensory, as 
seen in deadly spasms, both before and after collapse ; and here 
the grand remedy is bloodletting, carried as far as is necessary 
totally to subdue the spasms. We speak here with some quali- 
fication, agreeably to the creed that we have laid down, which 
is, to cull our knowledge at the bedside, where we must always 
look for contraindications, and even then we are but feebly 
armed, not "twice." We are pleased to see the writer from whom 



NOTICE OF THE EMPLOYMENT OF SULPHURIC ACID. 241 

we have just been quoting, conclude his observations thus : 
" We have seen trials with the sulphuric acid, calomel, and 
opium, stimuli of various kinds, of artificial heat, hydrocyanic 
acid, saline injections into the veins, ice, &c; but our impres- 
sions remain as before, viz., that the best mode of treatment 
must be the one which is founded on sound therapeutic princi- 
ples, the principal symptoms being combated in turn." 

We deem it proper, before we dismiss this article, to express 
our regret that the writer before us should have expressed 
strong doubts about the non-contagiousness of cholera. " Among 
these (meaning other patients, it is said), we may mention a 
girl, aged twenty years, who came to the hospital. She was 
attacked with cholera, and died in twenty-four hours. Also, 
the case of a sister, at Bartholomew's Hospital, who had at- 
tended the cholera patient, under the care of Dr. Burrows, 
with great care and solicitude. We well recollect that she 
gave us, with much earnestness, full details touching the pa- 
tient just named, who had succumbed to the complaint, and 
soon afterwards she was attacked herself, and died in a few 
days. We are not contagionists, but must confess that this 
looks very much like immediate transmission." Not conta- 
gionists, and yet believe in the immediate transmission of the 
disease, or rather the cause of it being transferred from one 
individual to another. Can we, with any semblance of reason, 
admit two specific poisons into our etiology for the production 
of one and the same disease ? The predisponent cause of 
cholera was present in the city, and it being now here and now 
there, did not leave room to believe that the hospitals would be 
exempt more than other places, except so far as there was 
greater purity, which would shut it out ; but it is one of the 
characteristics of cholera to flit from place to place, not that 
we mean there is any removal, except so far as the loco- 
topical malaria, on the lower stratum of the air, may be wafted 
by the wind. But, again, the girls spoken of no doubt went 
into the hospitals with the disease in the state of incubation, 
and the disease occurring in the hospitals, was no more than 
what might have been seen in a common intermittent. Had 
those girls been exposed to the miasm of marshy grounds, and 
16 



242 EPIDEMIC CHOLERA. 

come to the institutions before the disease was developed, 
intermittent fever would have occurred just the same as did 
the cholera. To us there is not a doubt but those suspicious 
cases of contagion were nothing but coincidences ; but we may 
well suppose that the new circumstances in which these females 
were placed would lead to increased predisposition, or rather 
operate as exciting causes do : going into a public institution 
is no plaything to females ; the air is different, the food is dif- 
ferent, — all these and other things would conspire to produce 
cholera upon persons who had been previously subjected to the 
influence of the choleraic cycle, which has existed in London 
since 1832. The occultness of the choleraic constitution does 
not prove its non-existence, and, indeed, we do not see any 
other way in which we can account for the erratic character of 
the sequential disease, and we have only to look to the laws of 
electricity to see that, in its intrinsic nature, it was present, 
but gave evidence of its presence only by occasional manifes- 
tations of its existence, as is seen in the exhibitions of its 
power : the visible motor power of the latter seems to arise 
from regular laws of modification ; but the former awaits com- 
bination. A new and congenial material rises up, now here, 
now yonder, and the governing principle models the materies 
morbi into a new form, and the new compound poison usurps 
the place of ordinary miasm ; and where, in former time, bilious 
fevers were wont to prevail, we have cholera, which we believe 
to be really but a modification of the olden fevers. 

There seems to be some difficulty in accounting for the oc- 
currence of sporadic cases of cholera, under circumstances 
where there is no evidence of exposure to a miasmatic mate- 
rial. In ordinary fevers, the miasm of which must be a specific 
matter in the air, certain viscera become deranged in their 
functions ; there is, therefore, room for believing that the mor- 
bid products of the vicious secretions are in some degree for- 
tuitous — we mean that the secreted matters are not precisely 
of the same quality at all times, but certainly they will not 
disseminate contagious matter. We apprehend that the ingesta 
may, from defect of the digestive function, give rise to morbific 
material in the alimentary tube, and thus beget a foundation 



NOTICE OF THE EMPLOYMENT OF SULPHURIC ACID. 243 

for the production of cholera, where the choleraic principle is 
present, and -where not present we shall have cholera morbus 
or fever; but, of course, such a state of things could never 
occur epidemically. But fevers, the product of ozone, we have 
no doubt do sometimes happen in this way, and this view ac- 
counts for the occurrence of sporadic cases of summer fever 
appearing in the winter, when no general diffusion of the 
febrific fomites can exist out of doors. 

Is there not good reason for believing that bad food, or too 
free use of that that is better, does often produce fever with all 
the signs of our autumnal fever, and requiring the same treat- 
ment for their cure, and are often replete with danger? then, if 
we admit that miasm is the cause of certain fevers, and if this 
obtains with common fevers, we may safely conclude that the 
same will obtain in cholera under like circumstances, that is, 
the fomes may be generated within the body, and produce 
fever — common fever, under ordinary circumstances — cholera, 
should the choleraic principle or predisposition be present. 
That cholera is the product of something that did not formerly 
exist is too manifest to be doubted ; but it seems to be over- 
looked that the exciting cause may be fortuitous, so far as the 
disease occurs sporadically, — thus fear, inebriety, exposure to 
cold damp winds, and other things which might be mentioned, 
excite cholera ; but this can only take place when a specific 
cause is present, which we suppose to be an occult principle of 
an electro-chemical compound. 

This view of the subject enables us to explain how it is that 
certain articles, innocent in themselves, may, during the ap- 
pearance of cholera epidemically, produce cholera so imme- 
diately after their use, as to leave no doubt of their deleterious- 
ness. This was a phenomenon occurring so frequently in Balti- 
more, in 1832, as to satisfy almost every observant person that 
fruits and vegetables did give rise to the disease in all the 
forms of its malignancy. A person in perfect health, as to 
bodily feeling, but generally (perhaps always) under the influ- 
ence of more or less diarrhoea, has often been seen to be over- 
taken with violent spasmodic pains, and when cholera was 
brought on in that way, however violent, copious bloodletting 



244 EPIDEMIC CHOLERA. 

was almost a specific; but to make it efficient, it was necessary 
to carry the abstraction of blood to complete arrestation of the 
pain. In a foregoing part of this work, we have detailed some 
remarkable cases of this sort. 

Can we avoid believing, in these cases, that the choleraic 
principle is present and ready to be roused into action ? This 
originates the question, how the true cholera is occasioned? 
That there is a universal choleraic principle co-extensive with 
nearly the whole terrestrial world is certain ; or, call it what 
you will, there is something new, which has quality, duration, 
uniformity of character, and destructiveness, and, although to a 
certain extent ever changing its phases, that phase, viz., its 
variableness, may be considered a fixed law in the governance 
of this pestilential entity. It is seen that miasm is the parent 
of common fevers, and that, as regards localities, there is a 
kindred being ; but these fevers are ushered into being by va- 
rious exciting causes, and in the cholera there is good reason 
for supposing that there is a possibility that things present in 
the body, not exactly the same at all times, may produce the 
disease, owing to the chylopoietic viscera having a condition im- 
pressed upon them by a strong choleraic influence. In these 
circumstances, we have a predisponent cause, or susceptibility 
to a disease, which characterizes the disease according to the 
nature of the cycle existing in the atmosphere ; hence it is that, * 
in influenza, acknowledged to be the offspring of some vitiation 
of the atmosphere, the subjects of the disease, who have had, or 
have any chronic disease, or any part of the system known to 
be comparatively weak, are sure to feel the force of the disease 
in that part, whether general or local, although the case pre- 
sents the symptoms proper to the disorder. 

Once more, we believe the choleraic principle, constituting 
the present cycle of morbific aeriform influence, operates in a 
slight degree upon every human body, and, by its presence, 
begets a feeble susceptibility, which cannot give a morbid im- 
pression upon the living economy until the system is, so to 
speak, invaded by a certain malaria, or some internal degenera- 
tion of the ignesta, or some impairment of the secretive func- 
tions ; the choleric predisponent will give form to the disease, 



NOTICE OF THE EMPLOYMENT OF SULPHURIC ACID. 245 

and that disease will probably be in more or less force, accord- 
ing to the thing co-ordinate with the choleraic impression, or 
with that of the exciting cause, or sometimes influenced in its 
individuality by both the remote and exciting causes. In small- 
pox we see strong congenital predisposition or susceptibility, 
which has no impairing influence upon the healthy economy ; 
but the disease, having once traversed the system, with very 
few exceptions, destroys the variolous susceptibility, and ex- 
emption has been secured. What idea can we form of this won- 
derful phenomenon ? The pustulation seems to produce the ex- 
emption which follows, and seems to give some support to the 
ancient notion of concoction, by which the system is purged of 
some peculiar principle or thing in the animal economy. 

We are not prepared to say how far the same relative con- 
dition of matter belongs to cholera, but so far as our observa- 
tions have extended, and our recollections serve us, there has 
been but little attained on this branch of our subject ; there is, 
we think, some similarity. We have not seen, in many hun- 
dred cases, one second attack of cholera. There is, however, 
a striking difference in this. The system, as regards suscep- 
tibility to small-pox, is congenitally impressed ; whereas, cho- 
lera has quite a modern existence. With this difference, we 
ask, how stands small-pox and cholera relatively to the vaccine 
disease ? We do not feel prepared to offer an opinion here, 
affirmative of the substitution of vaccine for small-pox exerting 
an influence favorable to the production of cholera, but certain 
it is, some new element or principle has risen up, and it would 
seem that the tout ensemble of our knowledge respecting all 
things connected with the modern pest, shows that the pre- 
disponent to the extension of it is omnipresent. If this view 
be admitted, it will follow that all the speculative views about 
its being extended by contagion, according to the course of 
trade, in different countries, or transported from port to port 
in any one country ; or of its coming and going, or its migra- 
ting from one country to another, irrespective of a univer- 
sal pestilential principle, are without foundation, or, rather, 
founded in error. 

We have elsewhere noticed some instances of deadly spas- 



246 EPIDEMIC CHOLERA. 

modic pains occurring in several cases during the existence of 
epidemic cholera, so immediately after eating certain articles, 
that there was no room for doubt as to the article taken being 
the cause of the ailment. In these instances of seizure, there 
is strong reason for believing the morbid impress is made by 
direct disturbance of the nerves of the splanchnic system. 
This system is then in a state of incipient lesion, which lesion 
is the result of choleraic disturbance, and it would seem as if 
in these cases, the ganglionic centres, with their connecting 
nervous cords, have been primarily deranged in their func- 
tions ; for, as far as we have seen these cases, we have else- 
where noticed as being exceedingly violent, bloodletting would 
cure, with the co-operation of little or no aid from other reme- 
dies. Upon the whole, although we are aware of the para- 
mount involvement of the blood, and its more immediate asso- 
ciated apparatus ; still we believe that there is not only a close 
link between the sanguiferous system and the nervous, but 
that in some of the more sudden and painful cases, the nerves 
of the viscera are primarily involved in the disorder ushering 
in cholera ; and here we see reason for reprobating all attempts 
at empirical treatment of a disease, the characteristics of which 
may be said to be almost indefinitely diversified. 



OBSERVATIONS ON CHOLERA AT YORK, PENNSYLVANIA. 

On the 26th of September, two persons were attacked with 
symptoms of cholera in the night. A woman, aged about 
thirty, and her brother, aged eighteen years, were overtaken 
about the same hour, quite early in the morning, with profuse 
diarrhoea. A physician was called in early in the morning, 
when symptoms of the disease were already present, in the 
form of cholera lethalis. He directed the free use of cold 
water and ice, and small doses of chloroform later in the day. 
We were called into consultation in the afternoon, with three 
other physicians, and found the patients in the stage of pro- 
found collapse. Our proposal for giving table-spoonful doses 



OBSERVATIONS ON CHOLERA AT YORK, PENNSYLVANIA. 247 

of Sp. Turpentine, and the external application of melted hogs' 
lard was adopted ; and the turpentine repeated once in two 
hours. This somewhat abated the diarrhoea, and increased 
both the warmth of the body, which was at a great extreme of 
coldness, and the force of the pulse, in a few hours. In the 
evening, we had very slender hopes of the possibility of reco- 
very ; but they both died in the course of the night. 

At quite a late hour of the night, their relatives, in consi- 
derable numbers, were assembled, and sat up in the house 
where lay the dead bodies. One of them, a man who, it was 
said, was afraid of catching the disease, drank freely of some 
alcoholic drinks, so as to become alarmingly intoxicated. The 
mother of the young man wiped the sweat from his face, and after- 
wards wiped her own face with the same handkerchief. Many 
persons visited the house, and there was a pretty large funeral, 
yet not one individual was infected ; although in a day or two 
after the death of these individuals, one woman and a young 
man were seized with the cholera, which soon ended in death ; 
and a nurse who was with them, using great exertions, and 
losing sleep, was attacked, and also died of cholera. This 
last case, no doubt, had the same origin as that of those who 
died previously. 

The town of York is built upon a site somewhat ascending. 
There is a small river coursing along on the west and north 
sides of the principal part of the town, but running through 
part of it, and there is a street, called Water Street, which 
runs some distance along the margin of the river. Water 
Street is lower than any other part. In this lower street 
occurred five cases of real cholera, and they all ended fatally, 
and were the only ones that assumed malignant symptoms 
during the season ; but there was, at times, a good deal of 
diarrhoea and dysentery, so considered, but, no doubt, they 
were incipient cholera, in the form of cholerine and cholero- 
dysentery. The first two cases occurred at the north end of 
Water Street, and the other three at the south end, more than 
two squares distant, and where there was no intercourse be- 
tween the two families. We did not attend these cases. 

The borough of York is a healthy location, but it is slightly 



248 EPIDEMIC CHOLERA. 

subject to what we prefer to call bilious fever. What there is 
of that disease, is more frequently seen along and near Water 
Street than any other part of the town. It seems in place 
here to notice, that the climate or meteorological condition of 
the place is somewhat peculiar — the people being more subject 
to rheumatic affections and neuralgia, than obtains generally 
in this country ; and we do not see that it is attributable to 
the sensible signs of the weather, but, we think, rather, there 
is a sort of endemic morbific cycle prevailing. How long 
this may have existed, we are unable to say. Here, again, 
we may well insist that the things which appertained to those 
five fatal cases of cholera, are utterly irreconcilable with the 
notion of contagion, in any form or uegree ; and the smaller 
fields for observation in cholera, are more clearly open for de- 
cisive opinion than large cities. 

Before we conclude our account of York, we have to notice 
that there were several cases of fatal cholera in the surround- 
ing country. In a neighborhood, five or six miles from the 
town, there was a considerable number of fatal cases of cholero- 
dysentery, mostly children. In a few instances, several died 
in the same house. Several physicians were called into the 
neighborhood, but were all alike unsuccessful. How it was 
treated, we are unable to say, not having seen any of these 
cases. 

We shall conclude our observations on York, for the pre- 
sent, by the relation of one case of cholera, that was arrested 
at the "very nick of time," by active treatment. David Wil- 
liams, was an employee on the railroad between York and 
Columbia, distance ten miles. He had been going, during the 
epidemic, to the latter place, but the cars stop at the edge of 
the town, and his business did not call him into the town. On 
the 9th of October, we were called to see him at 12 o'clock in 
the night. His first remark, upon going into his room, was, 
" Doctor, I believe I am getting the ague, I am so cold." We 
we were informed that he had come home well, and ate a hearty 
supper, and went to bed early ; but soon afterwards, about 9 
o'clock, he was seized with purging and vomiting, and his wife 
said it seemed to her, that from the beginning till now, half 



CLIMATE OF SOMERSET COUNTY, PENNSYLVANIA. 249 

past 12 o'clock, there had not been five minutes that he had 
not been purged or vomited. The surface of his body was as 
cold as marble, his pulse frequent, and very feeble ; tongue 
coated brownish-yellow ; prostration great ; voice feeble. Here 
was clearly a true case of cholera. We prescribed one scruple 
of protochloride of mercury, and five grains of opium, divided 
into three pills, one to be taken instanter, and repeat every 
hour. Drink nothing but small draughts of green spearmint tea. 
The first pill speedily arrested the vomiting and purging, and 
he soon slept; but the pills were given, according to directions. 
In the morning, we found him much better, but very weak. 
Not the least stupor, or other sign of his having taken opium. 
He was conducted rapidly to health by the use of an alkaline 
mixture, described in different parts of this work, composed of 
5j. Subcarb. Sodse, 6 drops of 01. Sassafras, 60 drops of 
Laudanum, and pure water, ifvi. Tablespoonful doses every 
two hours. In four days he resumed his business. 

We deem this case important, because, as far as we have 
seen, we believe, in like circumstances, stimulants would have 
been resorted to by many practitioners, on account of their 
possessing supposed specific choleraic virtues. Directions were 
given to observe extreme caution in the use of solid food for a 
few days. His wife was all attention, and he was visited more 
by his friends than we approved of, and yet, unlike any mar- 
vellous spread of the choleraic nothingness, that is thought to 
be dispensed by the sick, or left behind by the dead, no one 
suffered. Could anything more utterly absurd occur, than to 
have subjected this man and his family to any sort of seclusion? 
Yet it has been countenanced by Dr. Carlton. When one of 
the physicians in Sweden says, " whatever difference of opinion 
there may be about shutting cholera out, all are agreed that ive 
should shut it in." 



CLIMATE OF SOMERSET COUNTY, PENNSYLVANIA. 

We deem it within the proper scope of our subject to bring 
into view the meteorological condition of Somerset County, 



250 EPIDEMIC CHOLERA. 

Pennsylvania, a district of country between the Alleghany 
Mountains and Laurel Hill, which district has some resemblance 
to the constitutional character of the atmosphere of York, as it 
stands related to the human body. We are aware that we use 
the term meteorological constitution in a sense somewhat new, 
but we consider the atmosphere as having its occult qualities, 
as well as those recognized in its sensible signs. 8 

The town of Somerset is surrounded by a country tolerably 
level, and at a great height above the shore of the Atlantic ; 
but the mountain boundaries on the east and the west are 
elevated considerably above what may be termed a broad 
valley. The winter is longer, and sometimes more severe than 
it is on the east or west side of the mountains. The principal 
products are potatoes, flax, field peas, and oats ; wheat does 
tolerably well, but rye is more congenial to the climate and soil ; 
maize does not ripen, peaches cannot bear the season, apple- 
orchards sometimes bear, but the trees become covered with long 
green moss, which, at a distance, in winter, gives the appearance 
of pine or cedar. When quite young, we practised medicine 
two years in Somerset, and we never saw a case of intermittent 
or remittent fever which originated in Somerset County. At 
Cumberland, thirty miles distant, and eastward of the Alle- 
ghany Mountains, bilious fever prevails. One gentleman, who 
had suffered long at Cumberland, came to Somerset with an un- 
conquerable ague. In a few weeks, with some mild treatment, 
he regained fine health, and became a resident of the town of 
Somerset, and had no return of his fever. 

There are large glades, which abound in fine grass, and in 
other parts of the country there are several fine forests of 
valuable pine timber. The seasons are liable to great changes. 
We once saw the thermometer in the shade at 97£°, and we 
saw ice as thick as a case-knife, in a meadow, in the month of 
August; and, we believe, slight frosts are to be seen every 
month in the year. We shall pause here, and have only to 
say further, that the meteorological condition of the atmo- 
sphere is different from that of any other part of the Middle 
States ; but in respect to any prevailing morbific influence of 
climate, there is a similarity to that of York County and town. 



ATMOSPHERICAL OZONE AND CHOLERA. 251 

Rheumatism was common when we were at Somerset, and also 
hypochondriasm ; but, in two years' practice, we never saw a 
case of fever, excepting such as were symptomatic of some 
bodily injury. This is an important fact, because it corrobo- 
rates the opinion that morbific cycles or constitutions exist 
under different modifications. Thus we see that, in many lo- 
cations throughout the United States, miasmatic diseases pre- 
vail in different degrees, as well in respect to more or less 
severity as to the amount of cases ; while, at Somerset, the 
people are wholly exempt from all such diseases ; in York, 
though bilious affections exist in the summer and fall months, 
still, comparatively, " they are few and far between." All 
these facts have an important bearing upon what we are very 
anxious to prove, that, as is the aerial constitution, so will 
be the diseases ; but it is necessary, in examining this subject, 
to bring into view, that bilious maladies are produced by things 
visible, while others are occult, and only to be known by their 
results. Thus we see that even rheumatic affections have, so 
to speak, their predilections ; or in other words, are under some 
occult influence ; while epidemic cholera, although wide spread 
as the inhabited world, thereby shows that the usher of the 
disease is but a predisponent cause ; otherwise, it would de- 
populate the whole world, were its usher a virulent contagion. 
Its power, though universal, is feeble and unseen, and like the 
electrical phenomena that sometimes come before us, alike in- 
visible and mild, until roused into action, when it shows a 
power altogether resistless. It will be perceived here, that 
while the term constitution applies equally well to permanent 
peculiarities of the atmosphere, as to those that are in some 
degree periodic; the term cycle can only be applied to the 
latter condition ; and again, permanent morbific or sanative 
conditions establish climates. 



ATMOSPHERICAL OZONE AND CHOLERA. 

"According to Professor Schonbein, the discoverer of cotton- 
powder, a complete absence of ozone has been remarked in the 



252 EPIDEMIC CHOLERA. 

atmosphere of Berlin during the invasion of cholera. Dr. 
Boeckel, of Strasburg, informs us, that in that town also, the 
presence of cholera coincides with the absence of ozone — that 
ozone reappears as soon as the epidemic has decreased. 

"Dr. Billiard, of Corbigny, is of opinion, the diminution of 
ozone in the atmosphere is the first cause of cholera, and that 
this modification of the air brings forth a change in the animal 
organization, in consequence of which, the liquids contained in 
certain vessels, and the substance contained in the digestive 
tube, are withdrawn from vital action, and only remain subject 
to the forces by which inert matter is ruled. 

" Thus the production of putrid fermentations, the disengage- 
ment of gases, and other physical phenomena, by means of 
which, according to Dr. Billiard, ' all the morbid symptoms of 
cholera, from its period of incubation to its fatal or favorable 
termination, may be explained.' 

"What is ozone? To this question we will endeavor to give 
a comprehensive answer, as the subject is well worthy atten- 
tion, and its assiduous study, added to daily meteorological ob- 
servations, promises to be no less interesting to the physiolo- 
gist and pathologist than it is at present to the chemical 
philosopher. Ozone is nothing else than oxygen itself, but so 
different from the body to which, since Priestley's discovery, 
we are accustomed to give the name, that it has been extremely r 
difficult to find out its real nature. 

"Oxygen has no smell. Ozone, on the contrary, has a very 
penetrating odor, resembling, at the same time, that of chlorine 
mixed with air and of phosphorus or sulphur in combustion. 
It is the odor that manifests itself after repeated electrical dis- 
charges. The new permanent qualities acquired by oxygen, when 
it changes into ozone, is not confined to its smell alone. Its 
oxidizing power is much greater than that of common oxygen. 
The latter combines only very slowly with mercury at an or- 
dinary temperature ; the former, on the contrary, unites itself 
very rapidly with this metal. 

"Van Marum was the first who found this remarkable body, 
in 1785. Having at his disposal the great machine of Tayler's 
Museum, he excited sparks in a tube filled with oxygen. After 



ATMOSPHERICAL OZONE AND CHOLERA. 253 

five thousand sparks, the oxygen had acquired a smell, 'which 
seems to us/ says this natural philosopher, 'to be clearly the 
smell of electrical matter.' From 1785 to 1840, these remark- 
able experiments were completely lost sight of; but, in the 
latter year, Professor Schonbein, while decomposing water by 
a galvanic battery, remarked that the production of oxygen 
gas was accompanied by a peculiar smell, and published a paper 
on this subject. What was this new body ? A simple one, or 
a composition of oxygen and hydrogen or azote ? The inge- 
nious chemist left the question undecided, but gave the name 
of ozone to the odorous substance. 

"Eight years after, Mr. Williamson, a member of the Royal 
Society of London, pronounced, that as ozone is produced by a 
galvanic battery, developed by the electrical spark, or brought 
forth by the action of the air or phosphorus, it is a hyperoxide 
of hydrogen and azotic acid, or a mixture of the two. Pro- 
fessor Schonbein had, meanwhile, continued his researches. 
In 1850, he. expresses an opinion that azote is a highly oxy- 
genated combination of hydrogen. In 1851, Messrs. Mar- 
tignac and De la Rive came to the conclusion, after a series of 
experiments, that the ozone is nothing else than oxygen in a 
peculiar state of chemical activity impressed upon it by elec- 
tricity. Berzelius and Professor Faraday also believed in a 
simple modification of oxygen in an isomeric or allotropic 
state of the body. 

"Professor Schonbein, taking up the question a third time, 
ranged himself, in 1851, to the opinion of Martignac and De 
la Rive. Most chemists, however, still hesitated to admit the 
modification of oxygen; but the experiments published in 1852 
by Mr. E. Fremy and Edmund Becquerel, seem to have re- 
moved all doubts on the subject. Thus, ozone is only a pecu- 
liar form of oxygen produced by electricity, — a change analo- 
gous to that which the solar rays bring forth in chlorine by 
rendering its affinities more powerful, or to the modifications 
which are excited by heat in sulphur, phosphorus, and carbon. 

" This fact having once been admitted, the question natu- 
rally arose, whether the changes we bring about in our labora- 
tories are not produced spontaneously in the atmosphere? 



254 EPIDEMIC CHOLERA. 

and this was very soon affirmatively answered. Since 1850, 
Professor Schonbein had ascertained that ozone decomposes 
iodide of potassium, and concluded that the best reagent for 
finding out the presence of ozone is starched paper containing 
a small quantity of the iodide. Paper thus prepared and ex- 
posed to the action of the atmosphere, soon revealed the pre- 
sence of ozone. But it was evident that this singular body 
could not always be contained in the air in the same propor- 
tions, and to study these variations a scale must necessarily be 
found. An ozonometrical measure easily was established by 
dividing into ten shades the chromatic intervals between the 
absence of ozone, which is white, and the deepest color which 
this substance can possibly bring about by decomposing iodide 
of potassium. By means of this scale, the daily variations of 
the atmospheric ozone may be ascertained in the same manner 
as those of the temperature and weight of the air indicated by 
the thermometer and barometer. 

"Dr. Boeckel makes the following remarks: In summer, the 
ozonometrical mean is, according to my observation, constantly 
more considerable during the daytime than it is at night; the 
ozonoscopal paper being exposed from morning to evening to 
two maxima of electricity, while, during the night, the reactive 
paper only traverses one maximum period, which is between 
two and four in the morning. 

"In winter, the inverse seems to take place; the electrical 
affinities being then most likely energetic, in consequence of 
the absence of the sun, although experience seems to have 
proved that a greater quantity of electricity is produced in 
winter. 

"During a fog, the ozonoscope frequently marks zero, as 
only the rapid formation of vapors, or their precipitation in 
rain or snow, is accompanied by a disengagement of electricity. 
This took place during the last four months of last year, which 
were frequently foggy. The ozonometrical mean of these 
months has constantly been inferior to that of the remainder 
of the year. 

"Thus, we have here a body, the existence of which was not 
even suspected a few years ago, and which never ceases to act 



PROF. SCHONBEIN 'S VIEWS OF OZONE. 255 

upon us, and upon all animated nature. As to the intensity of its 
action, it cannot be doubted; for who can question that consi- 
derable variations in the oxidizing power of respirable gas has 
a powerful influence upon respiration, and, consequently, upon 
all the vital functions ? 

"According to Dr. Boeckel, malaria always shows itself with 
the zero of the ozonoscope, and the same takes place when in- 
termittent fevers are present. 

"According to Professor Schonbein, a considerable quantity 
of ozone was observed in the atmosphere at Berlin during an 
epidemic influenza, and under a medical constitution predis- 
posing to pulmonic affections, and the contrary took place 
under the reign of a gastric constitution. Finally, as we men- 
tioned at the head of the article, the cholera coincided with the 
absence of atmospherical ozone." — Medical Times and Gfazette 
for 1855. 



COMMENTS ON PROFESSOR SCHONBEIN'S VIEWS OF OZONE. 

The first paragraph in the foregoing paper announces, as 
the positive result of the observations of Professor Schonbein 
at Berlin, and Dr. Boeckel at Strasburg, that the presence of 
cholera "coincides with the absence of atmospherical ozone." 
Can we rely on this as an invariable phenomenon ? We have 
seen that, in 1834, cholera and yellow fever prevailed to a 
considerable extent at New Orleans epidemically at the same 
time, and more or less of this has been seen in other places. 
We have endeavored, in the body of this work, to show that 
the first branch of the cause of cholera has the quality of 
ubiquity ; that that elementary principle is most likely a modi- 
fication of electricity ; that its influence begets a predisposi- 
tion to that disease ; but for the production of cholera in all its 
phases, a second specific entity is requisite, probably allotropic. 
The union of these entities forms a dual malaria, and hence it 
is, that while we see a choleraic constitution existing, which is 
manifested in various ways, cholera lethalis comes suddenly, 



256 EPIDEMIC CHOLERA. 

but never remains for any great length of time. Having done 
some bad work it departs ; but soon we hear of its invasion of 
some other place, and in unmeasured time it comes again ; and 
these movements are so erratic, and have existed so long as to 
show that the choleraic entity has become a fixed integral of 
the air we breathe. This entity may be viewed relatively to 
cholera as in a negative state, while some local, or personal 
entity, in a positive state, enters into union, and that union 
gives rise to morbific phenomena, viz., cholera. 

We see from the wonderful discoveries of the distinguished 
chemists who are named in the foregoing paper, that wonder- 
ful advances have been and still are making, in relation to 
changes which take place in the circumambient air, and that 
some of these give rise to and control our diseases. That 
some changes were seen to occur from time to time has long 
been known by certain signs, as miasm, and other kinds of 
malaria, which give rise to epidemic diseases ; and also, act 
sporadically ; but we were compelled to place these entities as 
something occult. Advances in chemical science are gradually 
bringing things that were hidden to the light of scientific 
research. The luminaries who have advanced our knowledge, 
deserve the praise and highest admiration of mankind. But 
further advances are to be made before we can place our me- 
teorological entities on a basis from which we can cull such 
material or practical knowledge as will give us true guides in 
practice. 

We believe that the history, the nature, the symptomatology, 
the general character, the topographical preferences, the fore- 
runners, the similitude to other diseases, and the therapise most 
reliable, form a combination which enables us to understand 
the disease and its treatment irrespective of chemical develop- 
ments of the various principles or entities, which chemistry 
shows forth, but which, unfortunately, are subject to ever 
varying changes. Such has been the course of our studies 
from the first irruption of cholera in this country ; how far we 
have succeeded in developing a true manifest of the above 
morbific ensemble the reader will judge. 

Dr. Billiard, in paragraph first, alleges that there is a pre- 



APPLICATION OF SCHONBEIN'S VIEWS. 257 

vailing atmospherical contamination which deranges the animal 
economy, and causes changes of the fluids so as to withdraw 
them, together with substances in the alimentary tube, from 
vital action, and subject to the forces of inert matter. 

The same author in paragraph three, supposes that these 
changes lead to fermentations which produce gases that give 
rise to the train of morbific phenomena which characterize 
cholera. These views were adopted by us in greater part, in 
1832; but more fully carried out in the body of this work, 
before we had known of Dr. Billiard's views on cholera. 

Thus much we have thought proper to say of chemical re- 
searches and discoveries on the constitution and changes of 
the atmosphere, which, no doubt, produce and modify our dis- 
eases ; but we regret to say that, as far as our direct therapies 
are concerned, we are yet but at the threshold of our inquiries. 
The subject is nevertheless replete with interest, but calls for 
exact discernment of chemists of extensive experience. In 
concluding our remarks on this branch of our subject, we wish 
to call the reader's attention to the following exposition : In 
ordinary epidemics, the general atmosphere only modifies our 
fevers, so as to give peculiar features in relation to sthenic, or 
asthenic conditions of the system, with some tendency to one 
or more of the most important viscera ; and this condition of 
things only shows the existence of a morbific cycle ; and the actual 
cause of the epidemic is from things visible to our perceptions, 
viz., the gross material which produces miasm. In this case 
the cycle does not give rise to the ordinary miasmatic disease ; 
it only modifies and establishes its character. But in cholera, 
the atmospherical contamination gives character to, and con- 
trols the system in a peculiar abnormal condition ; and when 
the systematic taint comes into affiliation with a peculiar 
malaria, a dual poison is produced, and thus is originated the 
disease known as cholera. 



APPLICATION OF DR. SCHONBEIN'S VIEWS. 
If the experiments of Dr. Schonbein, already noticed, at Ber- 
lin, and those of Dr. Boeckel at Strausburg, are to be relied on, 
17 



258 EPIDEMIC CHOLERA. 

this new local malaria is changed from the form of miasm, 
being now deprived of its ozone ; for which experiments, see 
the early part of the present article, pp. 251-2. Then as ozone 
is oxygen compounded with electricity, and we see our diseases 
changed during the absence of ozone, and our old-fashioned 
fevers present while ozone is present, we hence derive important 
information. The ozonometer will indicate the quantity of that 
article present; and as sulphur, but more especially phos- 
phorus, in a state of combustion, affords a smell similar to that 
of ozone, may we not hope, by further investigation, to be en- 
abled to correct the malaria of some of our almshouses, as seen 
at Baltimore and Boston, for instance, where the cholera has 
existed with appalling horrors. What might be the effect of 
burning phosphorus or sulphur, or a combination of both 
during the presence of cholera, with a view of introducing an 
air, which, though non-sanitary, might be preferable to the 
local choleraic entity, which must be present so long as the 
pest continues. We are aware that such a proposal is only to 
be decided by actual trial. It may be, that adding ozone to 
the air of the house, may not answer our purpose — Nature has 
her own laboratories ; but her laboratories are far from being 
like those of the chemist. It is not likely that any evil would 
arise from prudent trials. 

We hold that the cause of cholera has two branches ; one 
general, and in the character of maternity ; the other loco- 
topical, and in parasitic union. Over this morbific maternity 
we have no control ; this is a product of a world-wide laboratory, 
and dwells alike in all places, being most likely a modification 
of electricity, and like it endowed with ubiquitariousness ; and 
therefore wholly out of our reach, and out of our power, while 
the loco-topical congener is manifested in things visible. Thus 
specialities of locations can alone give prevalence to epidemic 
cholera ; but institutional cholera and sporadic cholera are 
generated mysteriously, so far as we know at present. The 
loco-topical entity in such places probably arises in good de- 
gree from too much sameness in the diet, by which is produced 
a want of affinity between the ingesta and the grand tubular 
receptacle ; and this may lead to intestinal fermentation or other 



PRESERVATIVE POWER OF COPPER IN CHOLERA. 259 

gaseous operations which shall give rise to peculiar formations, 
and thus create within the body the second branch of cholera 
letlialis ; and to our apprehension, the parent branch is ever 
present, and has been so present in our country since the year 
1832. Cases must be erected on a choleraic foundation, but 
may be originated in the same manner as common cholera 
morbus. 

So far as we have observed, the condition of our compara- 
tively crowded institutions, prisons, penitentiaries, and alms- 
houses, the diet seems to contain too little of the bitter prin- 
ciple (see Paris), as well as too much sameness, and perhaps 
too little fat. If we are right in this opinion, occasional 
seasoning of food with orange and lemon peel would be both 
agreeable and sanitary, and other simple bitters ; also some of 
the green, raw esculents of the garden. There is a seeming 
objection to this view in seeing, that these outbreaks of cholera 
take place, and again disappear, while the same course of pro- 
cedure, as to the internal regulations, are still the same. But 
the human system is seen to have its recuperative power, and 
when assailed by violent disease, must either succumb, or the 
plastic forces presently assume the reign, and the pestiferous 
intruder is expelled. Unfortunately, however, in almshouses 
humanity comes broken down, either chronically diseased, or 
with their systems being ready recipients for morbific entities ; 
they fall easily, but have little power to get up : but violent 
diseases even here, are only curable by active medicine. How 
vastly important that we as much as possible shut out every- 
thing hurtful ; and that we bear in mind in the application of 
our therapise, that we have feeble stamina to work upon. 

The mortality has been fearful in some instances, and fur- 
ther endeavors may possibly lead to better results. 



PEESERVATIVE POWER OF COPPER IN CHOLERA. 

" Dr. Routh read to the Medical Society of London a memoir 
from Dr. Bury, D. M. P., on the preservative power of copper 
in cholera. Dr. Bury is the author of a work on Metalo- 



260 EPIDEMIC CHOLERA. 

Therapica, and it was in carrying out experiments on this sub- 
ject, that his attention was first drawn to this influence of 
copper. He first related a case of cholera which occurred in 
the Hospital Cochin, in which the external application of a 
copper band arrested cramps, and that unmistakably, as on 
the removal of the copper plates, the cramps re-occurred. He 
found subsequently, on inquiry, that workers in copper and 
brass were remarkably exempt from cholera. This was the 
result of a careful and personal investigation in nearly all the 
metallic workshops in Paris, in which from a hundred to six 
hundred (and over) workmen were employed. The individual 
workshops were given by name. In all these, the mortality 
never exceeded 5 in the 1,000, and in many it was actually 
null; and this in the midst of a neighborhood in which the 
population was decimated. Indeed, in many cases the wives 
suffered, while the workmen escaped. Dr. Bury was not satis- 
fied with this result, but investigated the matter in other coun- 
tries, — Sweden, Vienna (in Austria), Russia, Turkey, and Eng- 
land. In all, the same exemption was observed. In many 
cases, also, it was remarked that removal to a copper-mine, 
or even district, arrested choleraic symptoms. The exemp- 
tion of Birmingham, Sheffield, &c, he explained in this man- 
ner. The individual cases so tested, in round numbers, 
amounted to about 300,000. A review of all these facts led 
him to conclude, 1st, That nearly all metals with strong elec- 
tric affinities were in different degrees preservative ; but of all 
these, copper and steel ornaments were most so — the mor- 
tality being almost null among workmen engaged in working 
these two metals. 2d. With a view of resisting cholera, he 
recommended the presence of copper and steel ornaments in 
rooms, as also plates wofn next the skin on the body. 3d. 
In the treatment of cholera, the internal use of metals, espe- 
cially copper, in powder, in the metallic states, as also the 
application externally of plates." 

" These plates he calls armatures ; these he prefers to the 
salts of metals. The memoir concludes with an attempt to 
explain these phenomena, which he did not believe to depend 
on any electrical or galvanic influences. Indeed, these he con- 



PRESERVATIVE POWER OF COPPER IN CHOLERA. 261 

siders rather noxious than otherwise. He suggested : 1. That 
in the production of ozone by phosphorus, an atmosphere 
affected by copper might be so modified that the cholera could 
not exist in it. 2. It might be due to minute absorption of 
oxide of copper by the skin and lungs, acting in a similar man- 
ner upon the system." (London Lancet, for 1853.) 

We cannot imagine why Dr. Bury should ascribe the influ- 
ence of copper over cholera to its chemical solution in the 
atmosphere, rather than to an electrical influence. „ In the 
construction of galvanic apparatus, we find copper perhaps 
pre-eminently suited to the giving full power to the machinery ; 
and we believe it is a settled point, that. ozone is a chemical 
modification of oxygen ; and we shall hereafter endeavor to 
show that electricity is the medium by which the choleraic 
constitution has been extended over the surface of the earth, 
thus giving rise to an altered lower stratum of the air. And 
what shall we say to the fact, that " a copper band arrested the 
cramps, and that unmistakably, as on the removal of the 
copper plates, the cramps re-occurred?" How shall we be- 
lieve that so speedy an oxidation of the copper could take 
place, and recur so immediately upon the withdrawal of the 
metal? But the phenomena present are readily reconcilable 
with the known laws of electricity, which is known to exist 
under various modifications, and, indeed, is seen to enter into 
chemical combination, as in ozone. The modus operandi is 
not so much a matter of importance as the fully established 
matter of fact in the case, i. e., that copper "unmistakably" 
has the alleged prophylactic quality. This report comes sus- 
tained by testimony which is entitled to our guarded attention, 
not to yield assent but with marked caution, nor leave a thing 
replete with so much good to mankind, if true, without a 
zealous endeavor to know it, as it should be known. 

If the position which has been taken by Dr. Bury be esta- 
blished, results of vast importance may be expected in public 
institutions, with small expense, by merely introducing a few 
sheets of copper into the passages, or beside the beds of 
the inmates. We could not reconcile ourselves to the use 
of copper in the state of powdered metal, as a chief remedy 



262 EPIDExMIC CHOLERA. 

for cholera ; but there may occur cases where our want of 
success, in an epidemic, may be so great as to warrant a trial 
of the copper treatment ; but as we do not agree with Dr. 
Bury in the belief that the copper acts chemically, so neither 
do we believe the metallic powder to be the most reliable form 
of its exhibition. Upon the whole, we think the prophylactic 
power should be more fully established before we venture to 
make it a chief antidote in the treatment of cholera lethalis, 
and for the forerunners of this stage, we have medicines 
already quite reliable. 

Copper has long been known as an article of our materia 
medica, and has been used as an astringent, tonic, and also as 
an emetic. We have sometimes used it, and we think, with 
much advantage, as a tonic, in protracted cases of syphilis, 
attended with great debility, in alternation with bichloride of 
mercury and other mercurials ; and the reader may be aware 
that Cullen speaks favorably of the use of copper in epilepsy, 
in his Materia Medica. It seems proper, since copper in the 
form of subacetate is often formed in cooking vessels, to notice 
this metal as being readily acted on by acid fruits when cold ; 
many cases of poisoning occur in this way. It is, therefore, 
important to know that sugar used quite freely, both in the dry 
and liquid state, dissolved in water is a safe and speedy antidote. 



SUMMARY OF VIEWS OF THE PRIMARY CAUSE OF CHOLERA. 

Among the wonderful contrivances of the world, there is, 
perhaps, none more wonderful than the polarity of electricity 
in the form of magnetism. 

AVe see this modification of electricity, ever, like a gravita- 
ting force, tending to one point ; and yet that very polar force 
exists over the face of the ground, as we see in the phenome- 
non, that the polarity of a bar of iron is changed by keeping 
the non-polarized end stuck for some time in the ground. 

The amiable and gifted St. Pierre, in his Studies of Nature, 



SUMMARY OF VIEWS OF THE CAUSE OF CHOLERA. 263 

has offered some thoughts on the magnetic needle. We quote 
from memory. Speaking of the polar influence of electricity, 
he expresses the hope that the day may arrive when some 
other metal may be found to possess the quality of pointing to 
the east and the west, as the magnetized iron needle points to 
the north and the south. No such discovery has been made ; 
nor has any attempts been made to find out a thing so unlikely, 
but desirable. We think there scarcely can be a doubt of 
there being some new modification (at least new to Europe and 
the American continent) of electricity, which has extended 
itself from the more eastern countries, and in its main course 
spread westward. Reaching our country on its northern bor- 
der, it moved, south and westward, over considerable space ; 
first near the Atlantic. 

Such being the case, what other agent is there to which we 
could ascribe the appearance of epidemic cholera in its course ? 
It is true electricity has the quality of ubiquity, but this does 
not interfere with its change of place, as may be seen in the 
operations of the telegraph. All the known laws of electricity 
in all its modifications, serve to give it fitness for the agency 
of spreading a subtle entity, like the entity which gives rise to 
cholera. 

It is known that electricity is susceptible of chemical combi- 
nation ; and, a combination tangible to our senses is at hand 
to sustain our position, i. e., the oxygen of the atmosphere, the 
pabulum of our breath, so to speak, is inodorous ; but ozone is 
foetid, but the former may by simple electrization be con- 
verted into ozone, the acknowledged morbific entity of our 
autumnal fevers. Seeing then that we have agents whose 
fitness is every way suited to the production of the phenomena 
attendant upon epidemic cholera, and that there is no other 
agent which possesses a condition fit for the production of that 
epidemic, we think we have made a strong case — a case car- 
rying with it proof, as strong as any that can be seen in proof 
of anything physical, which admits not of absolute demon- 
stration. 

But so far, we have only established a sort of maternity to the 
cause of epidemic cholera. The disease, in its primary spread 



264 EPIDEMIC CHOLERA. 

westward, showed itself now here, now there, now zigzag, 
again turning back ; still, its most steady trait was its west- 
ward course ; and its preferences for fever locations, or the 
crowded city ; always showing its principal force in the lower 
portions of the surface of such districts or cities, in which it 
made inroads. 

This choleraic maternity only gives rise to a feeble contamina- 
tion of the air we breathe, and acts as a sleeping evil genius 
ready to be roused into mischief potential. Its affiliation with 
some other poison gives rise often, with slight premonition, to 
cholera lethalis. 

Respecting this evil additamentum we know nothing posi- 
tive, but, nevertheless, what we do know of it is highly 
valuable. We know that fever locations are made to give up 
their places, and that epidemic cholera for a brief space occu- 
pies their localities. Is this not proof that some change has 
taken place in the air ? Ozone is supposed to be what has 
long been termed miasm, but we see cholera prevailing in cities 
wherein little or no bilious fever is to be seen ; and, this too 
goes to show, that ordinary miasm is not the second branch of 
the choleraic entity ; and accordingly, it has been ascertained 
that ozone is absent from districts affected with epidemic 
cholera. This only goes to show that there is a choleraic 
matrix which gives rise to cholerine and cholero-dysentery, 
mostly some weeks before cholera lethalis takes place. 

Ozone disappears when cholera comes into an infested neigh- 
borhood ; and according to the experiments of Drs. Schonbein 
and Boeckel, as cholera retires, ozone (at least sometimes) 
resumes its place again. This goes to establish the belief, that 
owing to the influence of the choleraic matrix, an unusual 
combination of the elements constituting the malaria of cholera 
occurs, and this new compound fomes is formed of the com- 
mon elements of fever poison, the elements being differently 
combined. 

The appearance of cholera in districts where fevers do not 
prevail shows that ozone is not a principal integrant of the 
lethalic poison ; and, the constant presence of the choleraic 
matrix is evident throughout our country. The appearance of 



SUMMARY OF VIEWS OF THE CAUSE OF CHOLERA. 265 

cholera lethalis is sudden, and its presence comparatively brief. 
We here clearly recognize an affiliating agent or element. 
There is then an all-pervading maternity, as seen intheubiqui- 
tariness of cholera poison, which is to be viewed as giving 
rise to a peculiar morbific constitution to the atmosphere; but 
for the production of epidemic cholera lethalis, there must be 
added something which has taken the place of the poison of 
fever localities, and this we term the immediate cause of 
cholera. 

If the propositions which we have offered be admitted, we 
will have proved, that the primary cause of epidemic cholera 
is existent as the cause of the intestinal diseases which are 
seen, as "the beginning of the disease." For the production 
of cholera lethalis another cause is requisite ; and as there is 
no malignant cholera without the primary and secondary 
cholera entities, we have made out our case, i. e., that there is 
a twofold or dual cause involved in the production of cholera 
lethalis. 

The propositions which we here offer are not invalidated by 
the admission of the supposition, that the primary cause may 
be the efficient cause of the secondary. It only shows that the 
primary is always active, only, however, in moderate force, and 
it may tend to beget the secondary by affecting the material 
which is only an occasional material in the atmosphere, which 
becoming gradually embodied, is sooner or later dispersed by 
the winds, and probably is but of an evanescent quality. 

Nor do our propositions invalidate the belief that many 
sporadic cases of cholera lethalis originate, as do cases of 
common cholera morbus, i. e., they are sometimes produced by 
fortuitous secondary causes. Every one knows that excesses 
of almost any kind in our food and drinks, may produce 
cholera morbus. But now that there exists a choleraic matrix 
in the general atmosphere, we may reasonably believe that, 
the ingesta disturbing the alimentary tube including the 
stomach, disease, so produced, may assume the new species of 
cholera in all its stages. 

In support of the opinion here advanced we will briefly relate 
two cases. A few weeks ago, and at a time when there was 



266 EPIDEMIC CHOLERA. 

not to our knowledge a case of true cholera for several months 
in York, Pennsylvania, a man died very suddenly, with violent 
purging and vomiting, in the care of two or three physicians, 
who believed, from the suddenness of the death, that their 
patient had committed suicide. The body was opened, and 
nothing grew out of the post-mortem except that there was 
some large spots of deep redness in the inner coat of the 
stomach. A jury of inquest was called, and a searching in- 
vestigation had to decide whether the man had taken poison, 
for which there was no ground, except the violence of the 
symptoms, and the suddenness of the death. Inquiry showed 
that the patient had been complaining from Thursday till 
Monday before the symptoms became violent. This man 
beyond doubt died of true cholera, at a time when the secondary 
cause, without which cholera lethalis seldom occurs, was not 
present ; but, it was a case of cholera morbus taking on the 
livery of true cholera* 

In the month of March, 1855, we were called to see a woman 
of hale, hearty appearance, and we found her in the last stage 
of collapse ; and, she died in three or four hours after we saw 
her. She had been affected about forty-eight hours with all 
the usual symptoms of cholera ; and the disease was at once 
taken by her physician to be a case of true cholera, for which 
no evident cause was known. She was a working woman of 
good habits ; and lived in a neighborhood free from marshy 
grounds ; but she was a near neighbor to a man who had the 
same disease severely the year before, but he recovered under 
active depletive treatment. Do not these cases go far to prove 
two things? First, that there was a choleraic state of the 
atmosphere — the other that the disease was excited by a for- 
tuitous cause. And we may here repeat that, as these cases 
were single ones, the exciting cause was not specific ; and, on 
the other hand, wherever cholera prevails epidemically, there 
must be a sameness in the poison, present to an extent com- 
porting with the spread of the disease in each epidemic. 

We cannot reasonably attribute these occasional outbreaks 
in particular places, to the great choleraic matrix alone, seeing 
it is constantly in the circumambient air, as we know, for more 



NOTIFICATION BY THE ENGLISH BOARD OF HEALTH. 267 

than twenty years ; showing itself often enough to declare its 
presence, but like flights of fancy, soon satiated with the pos- 
session of its objects, and being forsaken by its congener, its 
virulence is lost, and then succeeds the more moderate, but 
sure possession of a world-wide choleraic domain. 



NOTIFICATION ISSUED BY THE ENGLISH BOARD OF 
HEALTH. 

We consider the notification before us a valuable paper, and 
we are made happy to observe a most striking likeness between 
this publication made in 1853, and what we published in 1832, 
in our Medical Journal. When we shall have given a copy of 
the English Report, we shall refer the reader to some pages 
of this work in corroboration of this assertion. 

"It is the painful duty of the General Board of Health 
to notify a third visitation of epidemic cholera. This disease 
again, first breaking out in Persia, has extended within the 
present year over a large portion of Russia, stretching as far 
northward as Archangel, on the shores of the Arctic Ocean ; 
it has ravaged Denmark, Norway, and Sweden, and then 
developing itself in the north of Germany, it has attacked 
Stettin, Berlin, Rotterdam, and Hamburg, and subsequently 
it appeared in England, again breaking out on its northeast 
coast, in the near neighborhood of the town in which it made 
its first appearance in the country in 1831. 

"In this wide-spread course it has everywhere overleaped 
the barriers which quarantine has erected to stay its progress ; 
where this means of protection has been most rigidly enforced, 
it has not only disappointed the expectations of those who 
have relied upon it as a safeguard, but often to the neglect 
and exclusion of the most important precautions, but has 
aggravated the evils of the pestilence, and added disastrous 
consequences of its own. 

"The experience already obtained of this pestilence at New 
Castle, Gateshead, and Hexham, is decisive that where the 
conditions are favorable to its localization and development, as 



268 EPIDEMIC CHOLERA. 

is the case in these towns, the disease has lost nothing of its 
virulence. In the two former, indeed, the severity of the 
disease, as far as it has yet extended, has greatly exceeded 
that of any former visitation, and it has attacked in all those 
places, as it has abroad, a much larger proportion of the mid- 
dle and higher classes — (owing no doubt to the longer exist- 
ence of the atmospherical choleric influence). 

"It is deeply to be lamented that in the interval of the last 
visitation of this pestilence and the present has not been 
generally employed in effecting a larger amount of improve- 
ment in our cities and towns. From such inspections as the 
General Board have recently been enabled to make of the state 
of populous districts, the former seats of the disease, in appre- 
hension of its appearance, they are compelled to state that 
there are extensive districts, and even towns, in which no per- 
ceptible improvements of any kind have been effected. On the 
other hand, there are instances in which, even where no works 
of improvement have been effected, better supplies of water, 
extensive flagging and paving, more frequent scavenging, and 
more active removal of nuisances in epidemic localities, have 
been accomplished. Combined and permanent works, involv- 
ing elaborate engineering measures, capable of remedying the 
neglect of years, cannot be effected in a few weeks. But the 
consciousness of past neglect should stimulate to immediate 
and resolute exertion, that all which the time requires may be 
done that ought to be done. The results in some instances, 
even of limited and partial improvements, are highly en- 
couraging. During the present epidemic at Hamburg, which 
has now been prevailing upwards of six weeks, only six cases 
of cholera have occurred in the improved parts of the city ; 
and during the whole of the epidemic in the metropolis, in 
1849, not a single case of cholera occurred in any part of the 
model dwellings for the poor, occupied by similar classes, 
though the pestilence raged in the districts in which the build- 
ings are situated, and there were instances of two and even 
four deaths in single houses close to their walls. 

" In towns where the greatest amount of improvement has 
been effected, and in which works under the Public Health Act 



NOTIFICATION BY THE ENGLISH BOARD OF HEALTH. 269 

are most advanced, much remains to be done, and may be 
done. Local Boards of Health are invested under the Public 
Health Act, with ample powers for cleansing, for the removal 
of nuisances, for preventing the carrying on of unwholesome 
or noxious trades in such a manner as to injure health, for 
preventing the occupation of cellars as dwelling-houses, which 
on the certificate of an officer of health, shall appear to be in 
such a filthy and unwholesome state as to endanger the health 
of any person, until such houses have been properly and 
effectually whitewashed, cleaned, and purified ; and for ad- 
ministering the common Lodging-house Act, the provisions of 
which are most important. All these powers should be exer- 
cised at the present juncture with extraordinary activity, 
vigilance, and stringency. 

"But though it may be needful to prosecute the work of 
cleansing more vigorously than in ordinary periods, it should 
be done under supervision, and with extraordinary care. In 
removing accumulations of filth, precautions should be taken 
for disinfection, and for preventing the increase of evapora- 
tion. The contents of foul drains, sewers, and ditches, should 
in no case be spread upon the surface, and no large accumula- 
tion should be removed excepting under the direction of a 
medical officer. The escape of a noxious effluvium is far more 
dangerous in an epidemic than in an ordinary season. 

" The evil of overcrowding, so general, not only in lodging- 
houses, but in tenements of all descriptions occupied by the 
poorer classes, especially by the Irish; an evil preventable, 
and to a considerable extent removable — should be at once 
and by all practicable means reduced. 

" Wherever local Boards of Health exist, they should in all 
cases co-operate with the Boards of Guardians ; and it is 
believed that the Boards of Guardians will, on their part, co- 
operate with local Boards. The existing means for the extra- 
ordinary service now required are divided among independent 
local jurisdictions ; medical officers in England and Wales 
being under Boards of Guardians ; works of sewage, and 
cleansings in towns not under the Public Health Act being 
under Town Commissioners, acting under local acts, and the 



270 EPIDEMIC CHOLERA. 

enforcements of orders required for the public service being 
with the magistrates or municipal authorities. It is confidently 
expected that a common feeling will give precedence to the 
branch of service specially needed on this occasion, and in- 
sure that unity of action which it is the main object of the 
rules and regulations issued herewith to authorize and pro- 
mote for the common object. 

"Experience has shown that, in the actual outbreak of the 
epidemic, the chief measures to be relied on for checking its 
spread, are those which prevent overcrowding, and the remo- 
val of persons from affected houses, and bringing the infected 
population under prompt and proper treatment during the pre- 
monitory stage of the disease. During the epidemic of 1849, 
an organization for effecting these objects was brought into 
operation, the main parts of which were the establishment of 
a house to house visitation, the opening of dispensaries and 
houses of refuge, in affected districts, for the reception of such 
indigent persons as appeared to be in imminent danger, re- 
siding in the most filthy and crowded houses, for the gratuitous 
supply of medicines, the establishment of houses of refuge for 
the reception of those who could not be properly treated at 
their own homes, and, in some instances, the supply of tents 
for the removal of the most susceptible and destitute classes to 
a distance from the infected localities. The result of this sys- 
tem was, that out of 130,000 premonitory cases brought under 
its operation, no fewer than 6000 of which were on the point 
of passing into the developed stage, only 250 went into the 
collapsed stage of cholera, or 1 in 520. But of the 43,737 
under visitation in the metropolis, including 978 cases on the 
point of passing into the collapsed stage of cholera only 52 ac- 
tually did so — not 1 in 800; so that, taking together the 
general result of this extended experience, it appears that the 
proportion of cases under early treatment, which passed from 
the premonitory into the developed stage, varied from 1 in 500 
to 1 in 800. 

"No doubt is now entertained of the efficacy of this system, 
or of the duty of local authorities to carry it into effect on the 
very first appearance of this disease in epidemic form ; and as 



NOTIFICATION BY THE ENGLISH BOARD OF HEALTH. 271 

none can tell when, or where, or how suddenly the pestilence 
may alight, it is the duty of local authorities to be prepared 
for the emergency before its arrival. Preparation will be at- 
tended with little cost ; the power to act with promptitude and 
efficacy, when the necessity for action arises, will be attended 
with a great economy of money as well as of life. 

"With reference to those precautions against the disease, 
which an individual may take for himself, or the heads of fami- 
lies or establishments for those under their charge, the most 
important are personal and household cleanliness, and the 
freest ventilation of living and sleeping-rooms with pure air; 
the purity of the air we breathe being even more essential than 
the whotesomeness of food and drink. 

"When the disease has actually broken out and become epi- 
demic in any district or locality, then the one essential precau- 
tion is not to neglect for a single hour any degree of looseness 
of the bowels. This symptom being commonly without pain, 
and so slight that it is difficult to conceive that it can be of the 
smallest consequence, naturally leads to neglect, and this ne- 
glect has cost the lives of thousands. Were any additional 
proof of this required, it would be found in the events that are 
now occurring at Gateshead; all the medical men there bear 
testimony that premonitory diarrhoea is all but universal, and 
that life depends on an instant attention to this symptom. 

"Thus one physician says: 'He has never yet seen a case 
without premonitory symptoms.' Another states: 'He has 
found in a great number of instances, where the men said they 
had first been seized with collapse, there had been neglected 
diarrhoea for twenty-four hours, or even forty-eight hours, or 
longer.' Another declares: 'In all cases of collapse investi- 
gated, there has been neglected diarrhoea. Even in the cases 
in which death takes place with the greatest rapidity, the sud- 
deness is apparent only, not real ; for the fatal collapse is the 
final but gradual result of diarrhoea neglected for several hours, 
and sometimes entire days. It must, then, be repeated that, 
in any district in which the cholera is epidemic, life may de- 
pend on obtaining prompt and proper relief for painless and 
apparently trifling looseness of the bowels.' 



272 EPIDEMIC CHOLERA. 

"The measure of prevention next of importance relates to 
proper regulation of diet. Great moderation, both of food and 
drink, is absolutely essential to safety during the whole dura- 
tion of the epidemic period; an act of indiscretion has been 
often followed by a severe attack ; intemperance at such a time 
is fraught with the most extreme danger. During the epidemic 
of 1849, sudden and fatal attacks of the disease followed im- 
mediately on the indulgence of habits of drinking after the 
weekly receipts of weekly wages. The interval between the 
meals should not be long, cholera being uniformly found to 
prevail with extraordinary intensity among the classes that 
observe the protracted fasts common in some Eastern countries. 

"The utmost practicable care should be taken against fa- 
tigue, which is a very powerful predisposing cause of the 
disease. Employers, and persons engaged in laborious em- 
ployments, should endeavor, as far as possible, so to arrange 
the amount and time of work as to avoid physical exhaustion. 

"Warm clothing is of great importance. During the pre- 
sent epidemic in Hamburg, it has been found that incautious 
exposure to cold or damp has brought on an attack as rapidly 
as improper food or excess. This precaution against damp is 
rendered doubly important by the peculiarity of the present 
season. Long-continued excessive rains have, in, many places, 
surcharged the ground with moisture, especially undrained low- 
lying districts, placing, in many instances, the land contiguous 
to towns, and beyond the usual range of town drainage, almost 
in the condition of marshes. The exhalations arising from a 
surface thus saturated, often with water holding decomposed 
matter in solution, spread to the towns, and affected the inha- 
bitants, however well drained the immediate sites of the town 
may be. The General Board were so apprehensive that dis- 
ease would be extensively produced by this unusual and danger- 
ous state of a large portion of the country (an apprehension 
which was subsequently realized by the breaking out of disease, 
allied in character to cholera, in sixty towns), that in their no- 
tification, issued in December, 1852, they represented to the 
local authorities that this calamity afforded a special occasion 
for administering extraordinary assistance to the poor, to enable 



NOTIFICATION BY THE ENGLISH BOARD OF HEALTH. 273 

them to keep large fires in their rooms, to protect themselves 
from cold and damp by warm clothing, to sustain their strength 
by solid and nutritive diet, and to counteract the predisposi- 
tion to the disease induced under these peculiar circumstances 
by suitable tonics, and other suitable remedies, under medical 
direction. This representation was made when there was a 
threatening of the return of cholera; it is now among us, and 
the General Board would remind the affluent that the oppor- 
tune supply to their poorer neighbors and dependents of whole- 
some food, warm clothing and bedding, and even such remedies 
(to be always in readiness) as their medical attendant may 
recommend for looseness of the bowels, is charity in the truest 
sense, and may be the means of saving many lives. It is also 
much to be desired that the General Board would strongly re- 
commend that the higher classes should co-operate with the 
clergy, who have done so much to promote the object of the 
legislature under the Public Health Act, in making frequent 
visits among the poor, and impressing upon them the impor- 
tance of following the instructions here laid down, with refer- 
ence to which there is a perfect accordance between the College 
of Physicians, and the General Board of Health. 

" In conclusion, after the large experience which has been 
obtained since the General Board of Health issued their first 
notification (1848), they can now repeat, with greater confi- 
dence, what they then urged — that, formidable as this malady 
is in its intense form and developed stage, there is no disease 
against which it is in our power to take such effectual precau- 
tion, both as collective communities and private individuals, 
by attention to it in its first or premonitory stage, and by the 
removal of those agencies which are known to propagate the 
spread of all diseases, or, where that may be impracticable, by 
removal from them. Though, therefore, the issues of events 
are not in our hands, there is ground for hopes and even con- 
fidence in the sustained and resolute employment of the means 
of protection which experience and science have now placed 
within our reach." — Medical News, 
18 



274 EPIDEMIC CHOLERA. 



EEMARKS ON THE FOREGOING "NOTIFICATION." 

Let us now briefly examine the principal subjects of this 
notification. It is asserted that cholera is not contagious; 
that it cannot be controlled by quarantine or other restrictive 
measures ; that there precedes outbreaks of the intense stage of 
epidemic cholera, epidemic diarrhoeas, which are the disease 
itself, in another stage of the malady; that in the primary 
stage the disease is easily and almost surely curable. Among 
the preventive means are public and personal purification and 
cleanliness, as well in household affairs as in wearing apparel ; 
that no filth, or receptacles for filth or materials undergoing 
decomposition, which may give rise to noxious effluvia, should 
be allowed to remain ; that no garbage or filth should be spread 
upon the ground ; and that lime should be spread over such 
material as is hauled out in the neighborhood of cities. 

The poor should be protected from the cold, especially 
dampness ; in spells of cold weather fire should be used, and 
fuel given to the poor wherever they need it; the people should 
dress warmer than might be essential in other than cholera 
times ; excesses and sudden changes are to be avoided. Fear, 
fatigue, nocturnal vigilance, potations of the ardent, and 
over-excitement should be avoided. 

The rich should improve, oftener remove, and build new 
houses for the poor ; as it will in the end be their interest to 
do. When there are signs of an outbreak, hospitals should be 
provided for the absolutely indigent, with every requisite in 
readiness for carrying the project into operation, so soon as the 
intense stage of the cholera makes its appearance. There should 
also, in the same good time, be a cholera dispensary, with the 
necessary physicians in readiness to enter upon their public 
duties, together with public apothecaries, so soon as there is 
clearly an epidemic disease present. Let the diet be reduced 
to a very simple kind, and diminished in amount. But, avoid 
making any changes too suddenly, unless at the juncture of a 
severe visitation. 

Let the people occupy the higher grounds, on an out- 



INFLUENCE OP COPPER WORKS ON CHOLERA. 275 

break of pestilence, and be removed from cellars ; from low 
grounds that are especially under the choleraic influence, 
they should be removed, before it assumes the lethalic stage. 
Especial pains should be taken to admonish the people of all 
conditions, to have some prophylactic ready by which they 
may hope to stay the progress of the symptoms of cholera, till 
a physician can be brought to the case. 

We have here given an epitome of the views, measures, and 
precautious of the English Board of Health, as set forth in 
their "notification," first published in 1848. And, if the 
reader will examine through that part of this work which treats 
upon the cause, nature, and measures of precaution, they will 
find that we adopted nearly all of the views of the English 
Board, and employed the same measures, in most of their 
details ; all which is to be seen in the Medical Recorder, pub- 
lished in Baltimore, by us in 1832, since which time we have 
not seen occasion to change one important opinion or measure 
then employed. And, if we admit the views, &c, of the 
English Board, we may claim, as do that Board, having been 
instrumental in saving much expenditure of money, and, what 
is more important, saved many lives, and laid a foundation on 
which we must rest our present experience and knowledge of 
epidemic cholera. 

We trust this claim, to having, in 1832, attained a position 
in relation to cholera which with our present knowledge we 
need not change, will not be considered as savoring too much of 
egotism. Our views have long been before a considerable part 
of American readers, and we are truly happy to have them 
espoused by the august Board of Health of England. The 
position here taken is not to be disputed, since our Journal was 
exchanged not only with Journals in this country, but also in 
London, Edinburgh, and other cities in Europe. 



INFLUENCE OF COPPER WORKS ON CHOLERA, AS SEEN AT 
BALTIMORE. 

Dr. William H. Baltzell, whose extensive practice in the 
south part of the city affords him opportunity for obtaining 



276 EPIDEMIC CHOLERA. 

correct knowledge for pointing out the true state of the case, 
has obligingly furnished us with the following notice of a well- 
marked influence, operating within limits so well defined, as to 
leave no room for doubt respecting the exemption of certain 
parts of the Federal Hill from cholera, even in its sporadic 
form, owing to the influence of copper suspended in the air. 

On the south side of the basin or harbor there has been 
extensive copper works in operation for several years (from 
1848 to 1854). Extensive smelting of the metal has filled the 
air with fumes of copper, to an extent to create, as was sup- 
posed, a nuisance ; such as to lead to much complaint by the 
people within its influence. Less than a mile from these works 
is a considerable hill, sufficiently high to afford an excellent 
site for the flagstaff for shipping signals on the Baltimore 
station. This hill is in a position to be reached by winds from 
the south coming from the copper works ; and this has been 
the most prevalent wind. The wind rising over the greatest 
elevation, and along either side of the hill, from some combi- 
nation of things and circumstances, is found to spread as it 
courses onwards within an angle of about thirty-two degrees, 
and the odor of the copper fumes can be smelt for nearly two 
miles. 

Within the space included in the described angle, there has 
never been a single case of cholera during the operation of the 
copper works, although the area in view includes the residence 
of several thousand citizens, of almost every sort. Last 
year there was a long continuance of south winds, during hot, 
dry weather, and yet the copper district was wholly exempt 
from cholera, while a considerable number of cases, amounting 
in some instances, just without the line, to an endemic, so that 
on the south side of the copper line, in some few houses, seve- 
ral persons died. And there died several horses and cows ; 
the deaths of which could only be attributed to an impure 
atmosphere. 

The case before us affords an interesting instance of the 
manner in which certain effluvia are carried abroad by the 
winds. We see here the wind being impregnated with the 
diffusible copper, and pressing on in one direction ; the cop- 



INFLUENCE OF COPPER WORKS ON CHOLERA. 277 

pered air as it advanced became more diffused; and there was 
a steadily diminished force by which alone can we explain the 
philosophy of the regular increased width of the angle. "We 
shall not undertake to say how much influence the hill, in the 
way of the coppered wind exerts, but it is probable that the 
obstruction in the way has something to do with the spreading 
of the wind, and that the sanitary area in view would not be 
so broad at its west end, were it not for the influence of the 
hill ; but the hill being in the way causes the wind to spread. 

We will not theorize or speculate on our present subject, 
but surely the facts already noticed are in a high degree de- 
serving of our attention. It is said in all diseases, " prevention 
is better than cure;" but in cholera the adage is tenfold more 
valuable, since prevention is our great purpose — a purpose to 
which every one in the medical profession and out of it, should 
take a deep interest. For it is as if some wild beast was let 
loose, and "seeking whom he may devour." 

Let us seek for his haunts, and we shall find that, although 
his chariots are aerial, and their courses erratic, the poison of 
his nostrils is seen to come and go ; and in his rambles he has 
preference for mud and mire, and crowded houses, and low 
places — has great love for drunkards and the high fed. He is 
a deep sleeper, and entails first a lethalic state, and afterwards 
the sleep of death upon his victims; the sluggard cannot climb, 
so neither can the cholera charioteer climb terrestrial heights. 
The cholera charioteer is robed in slipperiness and slime ; heed 
him, watch him, and you can keep him, with God's blessing, 
at bay; but he is not at all times to be braved; he has his 
times to do, and his times not to do ; but when he holds his 
gala days, naught but a guarded moderation in all things will 
turn aside his swift-flighted chariot of desolation and death. 

It is as though he came armed with "fire and sword," 
and arrows to pierce, poison to sicken, screws to twist the 
nerves, massy weights to crush the muscles ; the strong arms, 
and the wrists of washerwomen to wring out the fluids of the 
bowels; he comes with the propensities and the power of the 
vampire, to suck out your blood ; he exerts the art of the col- 
lier, and fills your veins with charcoal — he shuts up normal 



278 EPIDEMIC CHOLERA. 

outlets, and makes sluices of those that should be shut. He 
would drench you in cold water, for which purpose he constructs 
your skin into a parchment sifter, that the fluids of your body 
shall escape — he is prepared like one who would pummel you 
into ecchymosis, to paint you black and blue. Amid all the 
riot, amid all the conflicting abnormal strife, there comes the 
heavy dream, the incubus of death ; and he stuffs your brain 
with unvitalized blood, and sits sullen upon your power of 
thought ; and here too, as a last stroke, he deposits the urea 
of your blood, and makes your own body poison fatally your- 
self. 



SPECIAL OBSERVATIONS ON COLUMBIA. 

We well recollect that when a small boy, how we stood in the 
door of our father's house at night, on his farm, near York, 
Pennsylvania, and saw with a degree of awe that seemed to raise 
erect the hair on our head, the thing called will-with-a-wisp 9 
while we heard some domestic of the family relate frightful 
stories of persons having been led astray by attempting to ap- 
proach one of these false lights — by receding as the lost wan- 
derer drew nearer, the pursuer was decoyed into some ruin 
dire ; — and now we think we see observers striving to lead the 
unwary in the quagmire of contagion. 

There was a piece of meadow ground near the dwelling, low 
and inclining to swampiness. In damp weather a faint light 
was often seen to rest over a certain spot that was alluvial and 
rich ; and we have seen that light increase in brightness, and 
pass, something like a meteor over a strip of meadow, say 
from 80 to 100 yards wide, and over bushes, not less than five 
or six feet high, and light up the dry leaves of the bushes, so 
that they could be seen as clearly as under the light of a good 
lamp. The spot under notice had once been a fish-dam, 
but there being three dams in a row, it was found that there 
was too much evaporation ; and the middle one was either 
filled up, or suffered to fill up with the rain, and the upper 



SPECIAL OBSERVATIONS ON COLUMBIA. 279 

dam was applied to the use of water-fowl, and was called the 
duck dam. Within our earliest knowledge of these premises, 
the middle pond was filled up ; but the duck dam was con- 
stantly used by considerable numbers of ducks and geese ; and 
no doubt dead fish were consigned to slow decomposition 
about these ponds ; and hence probably, the cause of the ex- 
traordinary amount of phosphorescent effluvium. 

What do we recognize in this phenomenon ? Here is a spe- 
cimen of effluvium, which, if not quite tangible, is most clearly 
visible as a specimen of phosphorescent light. These phos- 
phoric entities are usually stationary, and being diffused over 
a larger space, seem like spectres to recede as we pass into the 
illuminated air. It, of course, is only when there is close em- 
bodiment of this effluvium, that it is liable to be carried off by 
the winds, as we have seen in its illuminating the foliage of 
the bushes. 

We have here a striking illustration of the nature of the cir- 
cumstances at Columbia. We have elsewhere noticed the 
things present, from which we may well believe a large amount 
of a certain malaria had acquired embodiment, and floated over 
the face of the water ; and this embodiment was the work of 
time ; for weeks the usual material for the production of miasm 
had existed ; but now, there must have been a sudden change, 
and in an evil hour there came a gale from the south, and 
blew directly towards and through the town ; and that night 
twenty-four persons were poisoned to death ; and twenty-five 
more were added the next twenty-four hours. 

It requires no effort of the imagination to see how an efflu- 
vium may rise up, either suddenly or more slowly, and, like 
the phosphorescent effluvia, be carried by the winds from off 
the dam and settle long enough in the town to infect the citi- 
zens. For the present, we do not know the exact processes 
through which the cholera poison passes. Doubtless there is 
a period of incubation having preparatory stages, which we 
may suppose resembles a slow fermentation, which, having 
arrived at a certain stage, is suddenly matured, and poured 
forth by the winds ; for, certain it is, that the highest intensity 
of this poison is of short duration ; and in the outbreak under 



280 EPIDEMIC CHOLERA. 

notice, while the invasion was of the very highest intensity, its 
duration was one of the briefest. 

We might here turn to the inquiry, how is it that while we 
can discern nothing new in respect to the things of the locality, 
and the material which is known to produce bilious fevers, sud- 
denly we see a new disease of a more fatal potency ? Let us 
see if we cannot illustrate this by a very simple chemical pro- 
cess, which we may see verified every day. The distiller puts 
together his mash of grain and barm, of a certain temperature 
and consistency, — in a few hours he has the product of alcohol 
ready to run off. This is the vinous fermentation ; but let 
him neglect the distillation, and in a short time he has the 
acetous fermentation set up from the very same material. We 
offer this merely to show that the same materials, placed in 
different circumstances, may afford quite different products. 
It may be noticed here, that ozone is the most durable tenant 
of the malarious districts, while cholera-poison is a more 
irregular visitor, which, in small places, hardly makes its 
visits hebdomadal. What becomes of the infection, should we 
admit it to be an animal secretion ? We have already examined 
this branch of our subject, and still consider it a matter of 
the very highest importance. 



CONCENTRATED VIEW OF CHOLERA. 

We have endeavored to present to view epidemic cholera in 
its various phases and habitudes, and we shall now attempt a 
condensation, or a more strict identification of the malady. We 
think proper, before we proceed to such identification, to offer 
a few remarks upon the physiology of certain parts, as seen 
under their peculiar impressibilities. We mean here the pecu- 
liarities which are to be seen in the sensibilities of the alimen- 
tary tube, (which might be termed the elementary tube.) 

We once saw a young bear, who had slipped his chain and 
found his way to the kitchen, in the absence of the cook, and 
turned over a kettle in which a loaf of bread was baking, and 



CONCENTRATED VIEW OF CHOLERA. 281 

nearly done ; and -while the hot steam poured out of the bread, 
he tore off pieces of considerable size and swallowed several of 
them, amid the most terrific howlings, and only quiet when 
dragged off. From this he suffered no injury, as far as could 
be seen afterwards. On another occasion, we saw a lad, ten or 
twelve years of age, incautiously swallow a spoonful of hot cider- 
soup, which produced instantaneous syncope. He dropped 
from his seat ; but soon revived, and made no further com- 
plaint. Whether he finished his meal, we do not recollect. 

Every day we see what we might suppose to be likely to 
produce dangerous injuries to the tubular receptacle, by our 
swallowing things hot, and things cold, besides, things acrimo- 
nious, as pepper, mustard, brandies, &c. ; and this limb of our 
good-natured dame, vis medicatrix naturae, bears them with a 
wonderful degree of patience, but pressed too far, impairment 
will come, as every transgressor, sooner or later, is made to 
know. Now and then, the great tube is overpowered by the 
abuse of cold water, and sudden death is the forfeit. 

Whatever difference we may see between the structure of 
the great reception tube and the aponeurotic and ligamentous 
structures, they have resemblance in this : that they have 
soundness of structure, with but little sensibility, compared to 
some other parts ; but let them become inflamed, or into a high 
state of irritation, and they become sensitive and painful in 
the highest degree. We once attempted to overcome the ina- 
bility to swallow liquids, in a case of tetanus, by passing a 
flexible tube into the stomach. The passing of the tube was 
in the highest possible degree painful, and the injection of a 
little fluid seeming like pouring in melted lead. The tube 
had to be withdrawn in haste, owing to the indescribable suf- 
fering of the patient. She died in a few hours ; but we had 
not an opportunity of examining the body, yet we feel confi- 
dent there was no inflammation in this case. 

We have elsewhere contended that cholera is the product of 
a new modification of electricity. This electric entity is seen 
to assail the primse vise with insalubrious secretions, as must 
be the case wherever the nervous influence is impaired, and 
diarrhoea and dysenteric symptoms appear epidemically. While 



282 EPIDEMIC CHOLERA. 

this state of things continues, we see cases where the nerves of 
nutrition are obviously in a condition of morbid sensitiveness ; 
and we now and then see, that things quite innocent in them- 
selves, coming into contact with the inner coat of the stomach 
or bowels, give rise to agonizing pain ; and now, as if a train 
of morbid influences had been laid, the entire system is found 
to be morbidly impressed. 

In one individual we have wasting discharges from the tubu- 
lar centre, upwards and downwards — oftenest the latter. In 
another, there is agonizing spasms. In another, a death-like 
debility ; distressing chills ; lividity of more or less of the sur- 
face of the body ; painful tension at the prsecordia. Amid all 
this, there is general lethargy, and hence the term cholera 
lethalis. After suffering more or less of these symptoms of 
the disease, the patient dies, and we are now introduced to our 



We find universal congestion, or rather stagnation; the 
blood is found where it should not be, and where it should be, 
it is not, and wherever it is found, it is spoiled ; charcoal has 
the place of oxygen ; membranes are mottled by turgescence, 
or blanched by the abstraction of blood ; the brain is soaking 
in carbonized blood, and there is general lethargy. We go to 
the base of the brain, and there we find heavy effusion of 
serum ; we may see traces of the same through the theca of 
the spinal brain, even to the cauda equina (see dissections at 
Moscow). Look at the skin, and you might almost imagine 
you have an Ethiopian. See the fingers clenched, and the 
limbs rigid, and sometimes exhibiting muscular action. With 
a picture like this before us (and this is no exaggeration), we 
may well say, from the crown of the head to the sole of the foot, 
there is naught but deleteriousness, and wherever the general 
lethargy is established, we have mostly the forebode of death. 

As pathologists in cholera, our track in pursuit of things 
abnormal bears likeness to a circle, and we know not where to 
begin our inquiries ; but we think, as well from the universal 
devastation of parts, as from the earlier phenomena attending 
the disease, we may reasonably ascribe the course of the 
malady to a gradual impairment in the nervous power — origi- 



CONCENTRATED VIEW OF CHOLERA. 283 

nating in the great splanchnic system, for here it is we first 
see signs of disease. 

We have seen that notwithstanding the wonderful endow- 
ments of the alimentary tube, including the stomach, by which 
it bears much, that it is liable to be impressed with the highest 
possible irritation, so that in a choleraic season, an innocent 
article taken into the stomach may give rise to cholera, which 
shall assume its highest intensity, as respects sufferings, in a 
few minutes. 

Here seems to be the place of incubation ; the terminal ends 
of the nervous fibres are at fault ; the process of assimila- 
tion under their special keeping are performed imperfectly ; 
and eventually all the assimilating organs come into the fault 
of function, and now there is a new and disordered condition 
of affinities. 

There is in the end one universal disorder, and it is in vain 
to look to the pathology of cholera to find the seat of the 
disease ; its location is co-extensive with the limits of the in- 
dividual form ; the sensorium is co-extensive with the form of 
the man. The pathologist, in quest of the seat of cholera, is 
like one who finds the old clothes of a person who has run 
away. We are reminded here of the idea expressed some- 
where by Darwin, that the sensorial organs are co-extensive with 
the form of the man. Every one is aware of the nearly uni- 
form fact of epidemic diarrhoea preceding epidemic cholera ; 
and it is but reasonable to insist here, that all the abdominal 
viscera are involved in the derangement of function. These 
diarrhoeas are sometimes unattended by pain, but there is an 
abnormal condition of all the chylopoietic viscera, and the 
readiness with which such diseases are cured, is proof positive 
that the maternal cause exerts but a feeble noxious power on 
the system ; and it is quite probable that the parasitic cause 
gives the destructive intensity to the disease. Indeed, it is 
hard to conceive of any other condition of things than this 
plan of co-operation. Look at the extension of cholera, at 
its numerous appearances, and then at its temporary outbreaks, 
and how shall we explain these phenomena by any single 
agency ? 



284 EPIDEMIC CHOLERA. 

But we are chiefly anxious to establish the truth, that cholera 
has its place of incubation in the abdominal viscera ; and that 
incubation consists in insalubrious secretions. This we see to 
be the case in ordinary diarrhoeas and dysenteries ; and in 
bilious fevers. What then has been our experience in relation 
to those other affections ? Our universal practical experience 
has been to treat these affections by remedies suited to the dis- 
charge of offending viscous secretions, and to establish a more 
sanitary secreting condition of the abdominal viscera in parti- 
cular. Here comes to our aid the curative potency of such 
excitants as will aid the living organs to expel things noxious, 
and give normal impulses to the oppressed viscera. 

Here it seems necessary to go to the atomic entities of the 
body, and bring to view the process of perpetual renewal of the 
living structures, atomically, organically, and systemic. Atoms 
here are appliances, and have plasmatic, and eliminative 
qualities associated with motivity. Health consists in the 
regular operations of these infinitesimal entities. 

Looking at some great glandular structure, we see mem- 
branes, nerves, and parenchyma, &c, each has its own atomic 
entities ; and each has its own function. Here we see a sort 
of substructure ; and from this substructure there proceeds 
appliances for the use of other parts, as seen in the parotid 
gland, which sends its product to the stomach. There are 
other functions of elimination, as seen in the action of the 
kidneys. This part of our subject might be extended to great 
length ; but we think we have said enough to convey our 
meaning, and now for a brief application. 

We know that certain articles when taken into the stomach 
will produce emesis — that others will purge. Others again will 
act as sudorifics, diuretics, &c, &c. These phenomena are 
obvious to all persons, but there are other phenomena which, 
though less visible to the unlearned, are as well known to 
physicians as anything belonging to the science of medicine. 
We will only notice the influence of mercury over the lympha- 
tic system ; and we see with evident clearness this article and 
others, exerting a power over the biliary secretion, and over 
the abdominal viscera generally. 



CONCENTRATED VIEW OF CHOLERA. 285 

The prelude to cholera is a fault of function in the abdomi- 
nal viscera, as manifested in the epidemic diarrhoeas that pre- 
cede cholera lethalis. What is the most rational indication ? 
We say the most rational indication is to arrest the incubating 
tendencies, which is to be done by correcting the vicious 
secretions. But how is this to be done ? 

1st. The terminal nerves on the surface of the stomach 
are in a state of increased and morbid sensitiveness. Opium 
would seem to be the antidote here, but we find in the early 
stages, or mild cases, carminatives, as soda and sassafras, cam- 
phor, chloroform, cold water, ice, &c, will arrest the diarrhoea; 
and, this may be ascribed to these articles bringing the nervous 
influence, so to speak, to its senses ; and, doing its more nor- 
mal part in the atomic, plastic, and eliminative functions, which 
are now brought into healthful play ; and we have restored the 
secretion. 

2d. Whenever the nervous structures are highly sensitive, 
and there is agonizing pains about the praecordia, or violent or 
general spasms, we shall find the fault of function more deeply 
laid ; and here we must combine our soothing agent with one 
that will influence the fault of assimilation in the atomics ; 
for this purpose calomel and opium are the most reliable 
agents. 

3d. Is there profuse discharges upwards and downwards, 
which will speedily prostrate the general system, — four or five 
grains of opium, given according to the urgency of the case, at 
one, two, or three doses ; never at longer intervals than one 
or two hours, if given at the commencement of the lethargic 
stage (as seen in listlessness, weak voice, indifference, &c), 
will arrest the diarrhoea, and we have now time to attend 
to the urinary secretion ; and for this purpose eight or ten 
grain doses of nitrate pot. combined with five or ten grain 
doses of calomel, should there seem to be deep-laid atomic 
aberration. 

4th. Cases occur where, after eating, and sometimes from 
over exertion, &c, persons are brought into one blazing agony 
of suffering; here the lancet is the remedy ; and, for its success- 
ful application, bleeding must be carried on till there is complete 
relief from pain, and a more florid appearance of the blood. 



286 EPIDEMIC CHOLERA. 

5th. While internal remedies are employed, the application 
of hogslard will be found an important remedy ; a cup of hot 
water can be carried to the bedside, with a small one in the 
water and the lard in the small cup, will be found a convenient 
way of applying it : the patient being wiped dry, is to be freely 
rubbed with the lard. We have elsewhere treated fully of the 
treatment of cholera, but we have thought proper to say thus 
much, by which we hope to show the reader that according to 
the different phases, stages, and circumstances, remedies are 
to be individually applied. But we have deemed it a special 
duty to advise, that, according to our observations and ex- 
perience, seasons modify epidemic diseases ; and, by especial 
attention to this truth, at the beginning of an epidemic, we 
may soon establish a preferable treatment, and then manage 
our cases with comparative satisfaction to ourselves and to the 
greater safety of our patients. 

6th. The vast number of remedies that have obtained cele- 
brity for the cure of cholera, and the readiness with which it 
is seen to yield to remedies, in its early stages ; and, now and 
then in cases more profound, goes to establish the belief, that 
the predisposing cause is but a feeble poison ; and, experience 
abundantly proves, that precautions, and mild prophylactics 
are much to be relied on. 

Dr. Rush once said to us, the reverse of quod citofitcito perit, 
is true in medicine ; but in the treatment of cholera lethalis, 
what we do, we must do quickly, or decomposition of the blood 
will lead to the grave. 



3 47.7 



